Multimers of the HPV genome are generated in cervical tumors replicating as extrachromosomal episomes, which is associated with deletion and rearrangement of the HPV genome and provides a mechanism for oncogenesis without integration.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10239328PMC
http://dx.doi.org/10.1158/0008-5472.CAN-22-3030DOI Listing

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