A comprehensive analysis of 53 penile
carcinomas was performed to determine which mechanisms might be involved in the disruption of the
p16(INK4A)/
cyclin D/Rb pathway. To that end, human papillomavirus (HPV) presence,
p16(INK4A) expression and promoter methylation, and expression of the BMI-1 polycomb gene product were studied. Sixteen (30%) of the
carcinomas were found to harbour high-risk HPV
DNA, 15 of which contained HPV 16. HPV 16 E6/E7 oncogene transcripts were detected in 13 (87%) of the
carcinomas that contained HPV 16. Strong immunostaining for
p16(INK4A) was significantly more frequent in
carcinomas that contained high-risk HPV
DNA (p < 0.001) and amongst those with HPV 16
DNA, it was more frequent in lesions in which E6/E7 transcripts were detectable (p = 0.029). This supports an active role for HPV E7 in interfering with the
p16(INK4A)/
cyclin D/Rb pathway. Methylation of the
p16(INK4A) promoter or overexpression of the BMI-1 polycomb gene product may provide alternative modes of interference with this pathway. These phenomena were mutually exclusive and found in the absence of HPV in 15% and 10% of the penile
carcinomas, respectively. These data indicate that there are at least three plausible mechanisms by which the
p16(INK4A)/
cyclin D/Rb pathway can become disrupted during penile
carcinogenesis.