Val-Bernal J F, Pinto J, Garijo M F, Gómez M S
Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.
Am J Surg Pathol. 2000 Nov;24(11):1518-23. doi: 10.1097/00000478-200011000-00007.
Pagetoid dyskeratosis, is considered a reactive process in which a small part of the normal population of keratinocytes is induced to proliferate. The lesion is characterized by pale cells resembling those of Paget's disease within the epidermis. These cells have been seen as an incidental finding in a variety of benign papules most commonly located in intertriginous areas. Among the inductors of the lesion, friction is suspected. To the best of our knowledge, these pale cells have not been reported in the cervix. We describe the location of the lesion in the ectocervix and the incidence of this lesion in a group of 100 unselected patients surgically treated for uterine prolapse. Another group of 100 unselected patients treated for uterine leiomyoma was used as a control. Pagetoid dyskeratosis was found in 37 cases (37%) of uterine prolapse and in five cases (5%) of uterine leiomyomas. The lesion is more common in uterine prolapse (p <0.001) and is not significantly associated with cornification of the epithelium (p = 0.72343). The cells of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding squamous cells characterized by premature keratinization. Pagetoid dyskeratosis cells have shown positivity for high molecular weight cytokeratin and negative reaction for low molecular weight cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and human papilloma virus. Pagetoid dyskeratosis cells must be distinguished from artefactual clear cells, glycogen-rich cells, koilocytes, extramammary Paget's disease cells, and pagetoid spread of carcinoma cells to the cervix. In cases in which pagetoid dyskeratosis shows a florid expression, there is a hazard of overdiagnosis. The pathologist should be aware of the histologic features of pagetoid dyskeratosis in the ectocervix to avoid misdiagnosis and unnecessary treatment. Routine histologic study is usually sufficient to identify the lesion.
派杰样角化不良被认为是一种反应性过程，在此过程中，一小部分正常角质形成细胞被诱导增殖。该病变的特征是表皮内出现类似派杰病的淡染细胞。这些细胞在各种良性丘疹中作为偶然发现被观察到，最常见于皮肤褶皱部位。在该病变的诱发因素中，摩擦受到怀疑。据我们所知，这些淡染细胞在宫颈中尚未见报道。我们描述了该病变在子宫颈外口的位置以及在一组100例因子宫脱垂接受手术治疗的未经过筛选的患者中该病变的发生率。另一组100例因子宫平滑肌瘤接受治疗的未经过筛选的患者用作对照。在37例（37%）子宫脱垂患者和5例（5%）子宫平滑肌瘤患者中发现了派杰样角化不良。该病变在子宫脱垂中更常见（p<0.001），且与上皮角化无显著相关性（p = 0.72343）。派杰样角化不良的细胞显示出与周围鳞状细胞不同的免疫组化特征，其特点是过早角化。派杰样角化不良细胞对高分子量细胞角蛋白呈阳性反应，对低分子量细胞角蛋白、上皮膜抗原、癌胚抗原和人乳头瘤病毒呈阴性反应。派杰样角化不良细胞必须与人为形成的透明细胞、富含糖原的细胞、凹空细胞、乳腺外派杰病细胞以及癌细胞向宫颈的派杰样扩散相鉴别。在派杰样角化不良表现为旺盛表达的病例中，存在过度诊断的风险。病理学家应了解子宫颈外口派杰样角化不良的组织学特征，以避免误诊和不必要的治疗。常规组织学检查通常足以识别该病变。
