[Question #9578] Oral papilloma biopsy
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31 months ago
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Hello, I recently had a lesion in my throat removed and biopsied. I had just been diagnosed with genital warts and was concerned it was related. When the results came back the doctor called me assuring me it was nothing but when he sent me the biopsy report it was confusing as it read “final diagnosis: papilloma (see addendum)” the addendum then stated that they tested it for HPV strands 6&11, 16&18 and 31&33 to which they all came out negative. Then it read “clinical impression: R/o HPV, papilloma” my understanding is that R/o means to “Rule Out”
It seems the diagnosis was given on 12/14 and then the in Situ hybridization tests for HPV and clinical impression were done on 12/19”
My questions are
1. Does ruling out only these strains of HPV rule out the possibility of HPV?
2. Are there papillomas of the throat which do not contain HPV?
3. In cases of the throat, would the term “papilloma” be used as a generic term for a growth? It did not necessarily look like a typical cauliflower wart, more of a little tab of pink skin.
4 . Does it make sense to you that it would be diagnoses a papilloma on inspection but then ruled out after the in Situ hybridization
I have tried to reach out to the doctor for clarity but have not received a call back in weeks. So any clarity about what this diagnosis means would be appreciated. I understand a doctors concern is primarily the threat of cancer which this biopsy luckily ruled out, but I am also concerned with the risk of passing along warts to a partner.I also have some other small concerning growths on my gums which this diagnosis will effect how I move forward with getting them treated.
Thank you
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H. Hunter Handsfield, MD
31 months ago
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Welcome to the forum. Thanks for your question. It came in while I was online answering the question just before yours; most users should not expect nearly real-time replies!
On one hand, I can assure you that this is a trivial health issue, with no risk of a serious outcome, even if your oral papilloma is caused by HPV -- i.e. little or no risk of cancer. On the other hand, we STI experts have little or no experience managing oral HPV lesions. Assuming the doctor who did the wart biopsy is an otolaryngologist (ENT specialist), s/he probably has more experience and can answer your questions as well or better than I can. Jumping to your closing comment, I'm sorry you're having difficulty getting a reply from your doctor. Keep trying. You also might contact the laboratory that did the analysis, or (with luck) even the pathologist who signed off on the report. That said, here are my thoughts.
Perhaps most important, HPV 16 accounts for >90% of throat and other head and neck cancers due to HPV. With HPV 16/18 not detected, you can be confident you are at little or no risk for cancer from this problem.
To your specific questions, as best I can advise:
1,2. There are over 120 types of HPV, most but not all of which are sexually acquired and transmitted. You have tested negative for those types that together account for the vast majority (over 90-95%) of both oral warts and cancers. The term "papilloma" indeed suggests HPV, but I cannot say with certainty what proportion of oral papillomas are caused by HPV.
3. Yes, "papilloma" may indeed be used by some clinicians as meaning a growth that isn't necessarily a wart. However, I cannot say whether all pathologists -- i.e. whoever did the microscopist who analyzed your biopsy -- use the term in this way. Sorry.
4. The hybridization technique is only for identification of HPV, and probably is conclusive for the types of HPV analyzed. But as best I know, it is entirely unrelated to the determination whether a lesion is a wart, papilloma, etc.
As for transmission risk to partners, I really wouldn't worry about it. Both kissing and oral sex are believed to be an inefficient sources of HPV transmission. And you can safely assume your sex partners going forward have already been repeatedly exposed to and infected with HPV; exposure to any known infected source is really no more risky than contact with someone who happens to have been diagnosed HPV. And knowing you are not infected with the HPV types most likely to cause warts or cancer reduces their risk of an adverse outcome even more. Disclosure of known HPV infection to partners is a controversial topic, but that's my perspective on your oral papilloma: in my view, there is no need to change your sexual lifestyle or practices, or to inform partners. Your recent genital warts might be considered more important in this regard, however.
Sorry I can't completely answer your questions, but I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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