Foust R L, Dean P J, Stoler M H, Moinuddin S M
Department of Pathology, University of Tennessee-Baptist Memorial Hospital, Memphis 38146.
Hum Pathol. 1991 Jun;22(6):528-34. doi: 10.1016/0046-8177(91)90228-h.
The investigators report the clinical and pathologic features of 19 cases of intraepithelial neoplasia occurring in the anal canal mucosa of routinely excised hemorrhoidal tissue, a condition that has been infrequently described. The patients were 12 women and seven men having an age range of 21 to 74 years (mean, 48 years). Two patients had coexistent anogenital condylomata acuminata. Leukoplakia of the hemorrhoidal surface was noted in two patients. Intraepithelial neoplasia arose in the transition zone of the anal canal of 11 cases, in the squamous zone of three cases, and in both sites of five cases. All were high-grade intraepithelial neoplasms; one was classified moderate to severe dysplasia, 17 exhibited severe dysplasia/carcinoma in situ, and one contained microinvasive carcinoma. Both keratinizing and cloacogenic type neoplasms were observed. Associated koilocytotic atypia was identified in 16 cases (84%). In situ hybridization for human papillomavirus (HPV) messenger RNA demonstrated HPV RNA sequences in seven of nine neoplasms (78%) studied by that technique (five HPV type 16, one HPV type 18, and one coinfection with HPV types 6 and 18). Eighteen patients had no clinically evident recurrent or progressive disease at mean follow-up of 6.6 years. Residual/recurrent intraepithelial neoplasia was noted in one patient at 1, 2, 5, and 49 months posthemorrhoidectomy. Our data indicate that incidentally discovered high-grade intraepithelial neoplasia present in hemorroidal tissue is a clinically nonaggressive lesion frequently associated with HPV infection. Hemorrhoidectomy alone is curative in most cases.
研究者报告了19例发生于常规切除的痔组织肛管黏膜上皮内瘤变的临床和病理特征，这种情况鲜有报道。患者包括12名女性和7名男性，年龄范围为21至74岁（平均48岁）。两名患者同时患有肛门生殖器尖锐湿疣。两名患者可见痔表面白斑。11例上皮内瘤变发生于肛管移行区，3例发生于鳞状区，5例在两个部位均有发生。所有均为高级别上皮内瘤变；1例为中度至重度发育异常，17例表现为重度发育异常/原位癌，1例包含微浸润癌。观察到角化型和泄殖腔源型肿瘤。16例（84%）发现有相关的挖空细胞异型性。对9例肿瘤（78%）进行人乳头瘤病毒（HPV）信使核糖核酸原位杂交检测，结果显示其中7例有HPV核糖核酸序列（5例为HPV 16型，1例为HPV 18型，1例为HPV 6型和18型混合感染）。18例患者在平均6.6年的随访中无临床明显复发或进展性疾病。1例患者在痔切除术后1个月、2个月、5个月和49个月发现残留/复发性上皮内瘤变。我们的数据表明，痔组织中偶然发现的高级别上皮内瘤变是一种临床上侵袭性不强的病变，常与HPV感染相关。大多数情况下，单纯痔切除术即可治愈。
