Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas

BACKGROUND Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the cur...

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Veröffentlicht in:Cancer 2001-12, Vol.92 (11), p.2875-2884
Hauptverfasser: Klussmann, Jens P., Weissenborn, Soenke J., Wieland, Ulrike, Dries, Volker, Kolligs, Jutta, Jungehuelsing, Markus, Eckel, Hans E., Dienes, Hans P., Pfister, Herbert J., Fuchs, Pawel G.
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container_end_page 2884
container_issue 11
container_start_page 2875
container_title Cancer
container_volume 92
creator Klussmann, Jens P.
Weissenborn, Soenke J.
Wieland, Ulrike
Dries, Volker
Kolligs, Jutta
Jungehuelsing, Markus
Eckel, Hans E.
Dienes, Hans P.
Pfister, Herbert J.
Fuchs, Pawel G.
description BACKGROUND Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases. METHODS Nested PCR and an HPV16 specific single step PCR were used to screen 98 HNSCCs for HPV DNA for genital‐ and Epidermodysplasia verruciformis (EV)‐associated HPVs. Typing was performed by direct sequencing and/or sequencing of cloned amplimers. In two patients HPV16 subtypes in tonsillar carcinomas and their metastases were compared by amplification and sequencing of the long control region of the virus. In a subset of HPV16 positive tonsillar carcinomas and their metastases, localization and viral load were determined using laser assisted microdissection and real time fluorescent PCR, respectively. RESULTS Altogether 25 HNSCCs (26%) were found to be HPV positive. Stratified according to the tumor localization, the frequency of HPV positive lesions was 18% in the oral cavity, 45% for oropharynx, 25% for hypopharynx, 8% for nasopharynx, and 7% for larynx. The highest HPV DNA prevalence (58%) was found in tonsillar carcinomas. The high risk HPV type 16 was found in 84% of positive HNSCCs, in 14% of which EV‐associated HPVs were detected. Human papillomavirus sequences were detected in 64% of biopsies with normal mucosa from 11 patients with positive carcinomas. As a control group, 14 tumor free tonsils were analyzed. In none of these specimens were HPV sequences detected. Viral long transcriptional control region sequences in homologous metastases were identical with those in primary tumors and the load values in both locations were roughly comparable. Viral loads differed substantially in different areas of one tumor. Statistical evaluation of data related to clinicopathologic parameters showed a significant linkage of HPV with tonsillar carcinomas compared to other locations. Furthermore, a significant correlation of HPV status of tonsillar carcinomas with tumor grading and alcohol consumption was found. CONCLUSIONS Our study shows a preferential association of HPV‐DNA with tonsillar
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However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases. METHODS Nested PCR and an HPV16 specific single step PCR were used to screen 98 HNSCCs for HPV DNA for genital‐ and Epidermodysplasia verruciformis (EV)‐associated HPVs. Typing was performed by direct sequencing and/or sequencing of cloned amplimers. In two patients HPV16 subtypes in tonsillar carcinomas and their metastases were compared by amplification and sequencing of the long control region of the virus. In a subset of HPV16 positive tonsillar carcinomas and their metastases, localization and viral load were determined using laser assisted microdissection and real time fluorescent PCR, respectively. RESULTS Altogether 25 HNSCCs (26%) were found to be HPV positive. Stratified according to the tumor localization, the frequency of HPV positive lesions was 18% in the oral cavity, 45% for oropharynx, 25% for hypopharynx, 8% for nasopharynx, and 7% for larynx. The highest HPV DNA prevalence (58%) was found in tonsillar carcinomas. The high risk HPV type 16 was found in 84% of positive HNSCCs, in 14% of which EV‐associated HPVs were detected. Human papillomavirus sequences were detected in 64% of biopsies with normal mucosa from 11 patients with positive carcinomas. As a control group, 14 tumor free tonsils were analyzed. In none of these specimens were HPV sequences detected. Viral long transcriptional control region sequences in homologous metastases were identical with those in primary tumors and the load values in both locations were roughly comparable. Viral loads differed substantially in different areas of one tumor. Statistical evaluation of data related to clinicopathologic parameters showed a significant linkage of HPV with tonsillar carcinomas compared to other locations. Furthermore, a significant correlation of HPV status of tonsillar carcinomas with tumor grading and alcohol consumption was found. CONCLUSIONS Our study shows a preferential association of HPV‐DNA with tonsillar carcinomas. The data support the view of HPV negative and positive tonsillar carcinomas being different tumor entities and conventional cancer risk factors being of less importance in HPV‐infected individuals. The HPV genome is located in the cancer cells, whereas the infection of normal mucosa is a rare event. Data on quantification of HPV16 in tonsillar tumors and their metastases showed mean viral loads comparable to other HPV associated malignancies. Cancer 2001;92:2875–84. © 2001 American Cancer Society. Analysis of 98 head and neck carcinoma patients revealed predominant association of human papillomavirus (HPV) 16 DNA with tonsillar carcinomas. Distribution of HPV sequences, viral load, and data on epidemiologic risk factors suggest HPV positive tonsillar carcinomas represent a separate tumor entity.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/1097-0142(20011201)92:11&lt;2875::AID-CNCR10130&gt;3.0.CO;2-7</identifier><identifier>PMID: 11753961</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York: John Wiley &amp; Sons, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; DNA, Viral - analysis ; Female ; head and neck cancer ; human papillomavirus ; Human papillomavirus 16 ; Humans ; laser‐assisted microdissection ; Male ; Medical sciences ; Middle Aged ; Otorhinolaryngology. Stomatology ; Papillomaviridae - genetics ; Papillomaviridae - physiology ; Papillomavirus Infections - epidemiology ; Papillomavirus Infections - etiology ; Prevalence ; quantitative polymerase chain reaction ; Sequence Analysis, DNA ; Statistics as Topic ; tonsillar cancer ; Tonsillar Neoplasms - complications ; Tonsillar Neoplasms - virology ; Tumor Virus Infections - epidemiology ; Tumor Virus Infections - etiology ; Tumors ; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology ; Viral Load</subject><ispartof>Cancer, 2001-12, Vol.92 (11), p.2875-2884</ispartof><rights>Copyright © 2001 American Cancer Society</rights><rights>2002 INIST-CNRS</rights><rights>Copyright 2001 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5800-1a2df34fcd9a880208efb86bf1fee9bede35430c3bfd302fdc09a8699dc296383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2F1097-0142%2820011201%2992%3A11%3C2875%3A%3AAID-CNCR10130%3E3.0.CO%3B2-7$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2F1097-0142%2820011201%2992%3A11%3C2875%3A%3AAID-CNCR10130%3E3.0.CO%3B2-7$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,1428,27905,27906,45555,45556,46390,46814</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=13393395$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11753961$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Klussmann, Jens P.</creatorcontrib><creatorcontrib>Weissenborn, Soenke J.</creatorcontrib><creatorcontrib>Wieland, Ulrike</creatorcontrib><creatorcontrib>Dries, Volker</creatorcontrib><creatorcontrib>Kolligs, Jutta</creatorcontrib><creatorcontrib>Jungehuelsing, Markus</creatorcontrib><creatorcontrib>Eckel, Hans E.</creatorcontrib><creatorcontrib>Dienes, Hans P.</creatorcontrib><creatorcontrib>Pfister, Herbert J.</creatorcontrib><creatorcontrib>Fuchs, Pawel G.</creatorcontrib><title>Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases. METHODS Nested PCR and an HPV16 specific single step PCR were used to screen 98 HNSCCs for HPV DNA for genital‐ and Epidermodysplasia verruciformis (EV)‐associated HPVs. Typing was performed by direct sequencing and/or sequencing of cloned amplimers. In two patients HPV16 subtypes in tonsillar carcinomas and their metastases were compared by amplification and sequencing of the long control region of the virus. In a subset of HPV16 positive tonsillar carcinomas and their metastases, localization and viral load were determined using laser assisted microdissection and real time fluorescent PCR, respectively. RESULTS Altogether 25 HNSCCs (26%) were found to be HPV positive. Stratified according to the tumor localization, the frequency of HPV positive lesions was 18% in the oral cavity, 45% for oropharynx, 25% for hypopharynx, 8% for nasopharynx, and 7% for larynx. The highest HPV DNA prevalence (58%) was found in tonsillar carcinomas. The high risk HPV type 16 was found in 84% of positive HNSCCs, in 14% of which EV‐associated HPVs were detected. Human papillomavirus sequences were detected in 64% of biopsies with normal mucosa from 11 patients with positive carcinomas. As a control group, 14 tumor free tonsils were analyzed. In none of these specimens were HPV sequences detected. Viral long transcriptional control region sequences in homologous metastases were identical with those in primary tumors and the load values in both locations were roughly comparable. Viral loads differed substantially in different areas of one tumor. Statistical evaluation of data related to clinicopathologic parameters showed a significant linkage of HPV with tonsillar carcinomas compared to other locations. Furthermore, a significant correlation of HPV status of tonsillar carcinomas with tumor grading and alcohol consumption was found. CONCLUSIONS Our study shows a preferential association of HPV‐DNA with tonsillar carcinomas. The data support the view of HPV negative and positive tonsillar carcinomas being different tumor entities and conventional cancer risk factors being of less importance in HPV‐infected individuals. The HPV genome is located in the cancer cells, whereas the infection of normal mucosa is a rare event. Data on quantification of HPV16 in tonsillar tumors and their metastases showed mean viral loads comparable to other HPV associated malignancies. Cancer 2001;92:2875–84. © 2001 American Cancer Society. Analysis of 98 head and neck carcinoma patients revealed predominant association of human papillomavirus (HPV) 16 DNA with tonsillar carcinomas. Distribution of HPV sequences, viral load, and data on epidemiologic risk factors suggest HPV positive tonsillar carcinomas represent a separate tumor entity.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>DNA, Viral - analysis</subject><subject>Female</subject><subject>head and neck cancer</subject><subject>human papillomavirus</subject><subject>Human papillomavirus 16</subject><subject>Humans</subject><subject>laser‐assisted microdissection</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Papillomaviridae - genetics</subject><subject>Papillomaviridae - physiology</subject><subject>Papillomavirus Infections - epidemiology</subject><subject>Papillomavirus Infections - etiology</subject><subject>Prevalence</subject><subject>quantitative polymerase chain reaction</subject><subject>Sequence Analysis, DNA</subject><subject>Statistics as Topic</subject><subject>tonsillar cancer</subject><subject>Tonsillar Neoplasms - complications</subject><subject>Tonsillar Neoplasms - virology</subject><subject>Tumor Virus Infections - epidemiology</subject><subject>Tumor Virus Infections - etiology</subject><subject>Tumors</subject><subject>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</subject><subject>Viral Load</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkWtrFDEUhgdR7Fr9C5IvioXOek6yM5OsUlmmXgqlK6LoFwmZXDBlLmuyU-m_N8Ou3U8iQiDknCeHN3my7A3CHAHoSwRR5YAL-oICIFLAE0GXiK8pr4rlcnVxntdX9ScEZHDG5jCv169oXt3LZnc372czAOB5sWDfjrJHMV6nY0UL9jA7QqwKJkqcZfJjsDeqtb22p8T4uA2-Gbd-6E-J6g258UG1pB2UIYMjP8ZO9WSjNr5th06l5hgJluT8akV8T7ZDH1NHBaJV0L5PSHycPXCqjfbJfj_Ovrx7-7n-kF-u31_Uq8tcFxwgR0WNYwunjVCcAwVuXcPLxqGzVjTWWJbeAZo1zjCgzmhIYCmE0VSUjLPj7Plu7iYMP0cbt7LzUduUprfDGGVFWYVcVP8EkVORDIgEft2BOgwxBuvkJvhOhVuJICdJcvpqOX21_CNJilRFOUmSMkmSd5IkkyDrtaRyivB0H2FsOmsOc_dWEvBsD6ioVeuC6rWPB44xkVaRuO877pdv7e1_5vtbvEOR_QaOYLmM</recordid><startdate>20011201</startdate><enddate>20011201</enddate><creator>Klussmann, Jens P.</creator><creator>Weissenborn, Soenke J.</creator><creator>Wieland, Ulrike</creator><creator>Dries, Volker</creator><creator>Kolligs, Jutta</creator><creator>Jungehuelsing, Markus</creator><creator>Eckel, Hans E.</creator><creator>Dienes, Hans P.</creator><creator>Pfister, Herbert J.</creator><creator>Fuchs, Pawel G.</creator><general>John Wiley &amp; Sons, Inc</general><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20011201</creationdate><title>Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas</title><author>Klussmann, Jens P. ; Weissenborn, Soenke J. ; Wieland, Ulrike ; Dries, Volker ; Kolligs, Jutta ; Jungehuelsing, Markus ; Eckel, Hans E. ; Dienes, Hans P. ; Pfister, Herbert J. ; Fuchs, Pawel G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5800-1a2df34fcd9a880208efb86bf1fee9bede35430c3bfd302fdc09a8699dc296383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>DNA, Viral - analysis</topic><topic>Female</topic><topic>head and neck cancer</topic><topic>human papillomavirus</topic><topic>Human papillomavirus 16</topic><topic>Humans</topic><topic>laser‐assisted microdissection</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Papillomaviridae - genetics</topic><topic>Papillomaviridae - physiology</topic><topic>Papillomavirus Infections - epidemiology</topic><topic>Papillomavirus Infections - etiology</topic><topic>Prevalence</topic><topic>quantitative polymerase chain reaction</topic><topic>Sequence Analysis, DNA</topic><topic>Statistics as Topic</topic><topic>tonsillar cancer</topic><topic>Tonsillar Neoplasms - complications</topic><topic>Tonsillar Neoplasms - virology</topic><topic>Tumor Virus Infections - epidemiology</topic><topic>Tumor Virus Infections - etiology</topic><topic>Tumors</topic><topic>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Klussmann, Jens P.</creatorcontrib><creatorcontrib>Weissenborn, Soenke J.</creatorcontrib><creatorcontrib>Wieland, Ulrike</creatorcontrib><creatorcontrib>Dries, Volker</creatorcontrib><creatorcontrib>Kolligs, Jutta</creatorcontrib><creatorcontrib>Jungehuelsing, Markus</creatorcontrib><creatorcontrib>Eckel, Hans E.</creatorcontrib><creatorcontrib>Dienes, Hans P.</creatorcontrib><creatorcontrib>Pfister, Herbert J.</creatorcontrib><creatorcontrib>Fuchs, Pawel G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Klussmann, Jens P.</au><au>Weissenborn, Soenke J.</au><au>Wieland, Ulrike</au><au>Dries, Volker</au><au>Kolligs, Jutta</au><au>Jungehuelsing, Markus</au><au>Eckel, Hans E.</au><au>Dienes, Hans P.</au><au>Pfister, Herbert J.</au><au>Fuchs, Pawel G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2001-12-01</date><risdate>2001</risdate><volume>92</volume><issue>11</issue><spage>2875</spage><epage>2884</epage><pages>2875-2884</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases. METHODS Nested PCR and an HPV16 specific single step PCR were used to screen 98 HNSCCs for HPV DNA for genital‐ and Epidermodysplasia verruciformis (EV)‐associated HPVs. Typing was performed by direct sequencing and/or sequencing of cloned amplimers. In two patients HPV16 subtypes in tonsillar carcinomas and their metastases were compared by amplification and sequencing of the long control region of the virus. In a subset of HPV16 positive tonsillar carcinomas and their metastases, localization and viral load were determined using laser assisted microdissection and real time fluorescent PCR, respectively. RESULTS Altogether 25 HNSCCs (26%) were found to be HPV positive. Stratified according to the tumor localization, the frequency of HPV positive lesions was 18% in the oral cavity, 45% for oropharynx, 25% for hypopharynx, 8% for nasopharynx, and 7% for larynx. The highest HPV DNA prevalence (58%) was found in tonsillar carcinomas. The high risk HPV type 16 was found in 84% of positive HNSCCs, in 14% of which EV‐associated HPVs were detected. Human papillomavirus sequences were detected in 64% of biopsies with normal mucosa from 11 patients with positive carcinomas. As a control group, 14 tumor free tonsils were analyzed. In none of these specimens were HPV sequences detected. Viral long transcriptional control region sequences in homologous metastases were identical with those in primary tumors and the load values in both locations were roughly comparable. Viral loads differed substantially in different areas of one tumor. Statistical evaluation of data related to clinicopathologic parameters showed a significant linkage of HPV with tonsillar carcinomas compared to other locations. Furthermore, a significant correlation of HPV status of tonsillar carcinomas with tumor grading and alcohol consumption was found. CONCLUSIONS Our study shows a preferential association of HPV‐DNA with tonsillar carcinomas. The data support the view of HPV negative and positive tonsillar carcinomas being different tumor entities and conventional cancer risk factors being of less importance in HPV‐infected individuals. The HPV genome is located in the cancer cells, whereas the infection of normal mucosa is a rare event. Data on quantification of HPV16 in tonsillar tumors and their metastases showed mean viral loads comparable to other HPV associated malignancies. Cancer 2001;92:2875–84. © 2001 American Cancer Society. Analysis of 98 head and neck carcinoma patients revealed predominant association of human papillomavirus (HPV) 16 DNA with tonsillar carcinomas. Distribution of HPV sequences, viral load, and data on epidemiologic risk factors suggest HPV positive tonsillar carcinomas represent a separate tumor entity.</abstract><cop>New York</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>11753961</pmid><doi>10.1002/1097-0142(20011201)92:11&lt;2875::AID-CNCR10130&gt;3.0.CO;2-7</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Biological and medical sciences
DNA, Viral - analysis
Female
head and neck cancer
human papillomavirus
Human papillomavirus 16
Humans
laser‐assisted microdissection
Male
Medical sciences
Middle Aged
Otorhinolaryngology. Stomatology
Papillomaviridae - genetics
Papillomaviridae - physiology
Papillomavirus Infections - epidemiology
Papillomavirus Infections - etiology
Prevalence
quantitative polymerase chain reaction
Sequence Analysis, DNA
Statistics as Topic
tonsillar cancer
Tonsillar Neoplasms - complications
Tonsillar Neoplasms - virology
Tumor Virus Infections - epidemiology
Tumor Virus Infections - etiology
Tumors
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
Viral Load
title Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas
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