Andersen W A, Franquemont D W, Williams J, Taylor P T, Crum C P
Department of Pathology, University of Virginia Health Sciences Center, Charlottesville.
Am J Obstet Gynecol. 1991 Aug;165(2):329-35; discussion 335-6. doi: 10.1016/0002-9378(91)90086-7.
Vulvar squamous precancers (vulvar intraepithelial neoplasia) are associated with sexual factors, cigarette smoking, and human papillomaviruses. However, epidemiologic studies of invasive carcinoma of the vulva have produced conflicting evidence for these associations, in part because of a strong association with vulvar inflammatory disease (dystrophies) in older women. We analyzed a series of 42 vulvar invasive carcinomas for papillomavirus nucleic acids by deoxyribonucleic acid-deoxyribonucleic acid in situ hybridization and correlated their presence with age, smoking history, and morphologic type. The carcinomas were divided into well-differentiated, moderately and poorly differentiated, and intraepithelial-like growth patterns, the latter composed of nests of invasive neoplastic epithelium with preserved cell polarity, similar to intraepithelial disease. Of the lesions studied, 28% were human papillomavirus deoxyribonucleic acid-positive. Intraepithelial-like neoplasms segregated in women with a younger mean age (64 versus 73 years) than that of women with conventional squamous cell carcinoma and they more frequently had a history of cigarette smoking (88% versus 28%). Moreover, intraepithelial-like lesions contained human papillomavirus nucleic acids more frequently (67% versus 13%) when analyzed by in situ hybridization. These observations confirm the diverse nature of vulvar squamous cell carcinoma and may explain in part why conflicting results are obtained from studies investigating the role of sexual and viral factors in the genesis of vulvar cancer. They suggest that many invasive vulvar cancers may not be linked to papillomaviruses.
外阴鳞状上皮癌前病变（外阴上皮内瘤变）与性因素、吸烟和人乳头瘤病毒有关。然而，外阴浸润癌的流行病学研究对于这些关联产生了相互矛盾的证据，部分原因是老年女性中与外阴炎性疾病（营养不良）存在强关联。我们通过脱氧核糖核酸 - 脱氧核糖核酸原位杂交分析了42例外阴浸润癌系列样本中的乳头瘤病毒核酸，并将其存在情况与年龄、吸烟史和形态学类型相关联。这些癌被分为高分化、中分化和低分化以及上皮内样生长模式，后者由具有保留细胞极性的浸润性肿瘤上皮巢组成，类似于上皮内疾病。在所研究的病变中，28%为人乳头瘤病毒脱氧核糖核酸阳性。上皮内样肿瘤患者的平均年龄（64岁对73岁）比传统鳞状细胞癌患者年轻，且她们吸烟史更为常见（88%对28%）。此外，通过原位杂交分析时，上皮内样病变更频繁地含有乳头瘤病毒核酸（67%对13%）。这些观察结果证实了外阴鳞状细胞癌的多样性，并且可以部分解释为什么在研究性因素和病毒因素在外阴癌发生中的作用时会得到相互矛盾的结果。它们表明许多浸润性外阴癌可能与乳头瘤病毒无关。
