Frega Antonio, Lukic Ankica, Nobili Flavia, Palazzo Antonella, Iacovelli Roberto, French Deborah, Moscarini Massimo
Department of Gynecology, Perinatology and Childhealth, University Sapienza, Rome, Italy.
Anticancer Res. 2007 Nov-Dec;27(6C):4491-4.
Verrucous carcinoma is a rare variant of well-differentiated squamous cell carcinoma of the uterine cervix. Infection with high-risk human papillomavirus (HPV) is the main cause of intraepithelial and invasive neoplasias of the female genital tract, but the aetiology of verrucous carcinoma is still unknown. The aim of this study was to evaluate the presence of HPV in verrucous carcinomas of the cervix and to investigate the persistence and the role of high risk HPV types in follow-up.
Three patients, with atypical cytologies, were observed. All the patients underwent cytology and colposcopy followed by direct biopsy. The Hybrid Capture II microplate method was used for molecular detection of pre-surgical low- and high-risk HPV types. HPV tests were performed during the follow-up, annually.
The cytological findings revealed that atypical squamous cells "cannot rule out high-grade lesion" (ASC-H) in one case and high grade squamous intraepithelial lesion (H-SIL) in two cases. The HPV test detected high risk HPV types. Colposcopic findings showed cervical exophytic lesions. The histology revealed a well-differentiated verrucous carcinoma Ib stage, according to FIGO classification, in every case. Following radical hysterectomy, the post-operative course was uneventful. The mean follow-up time was 4.6 years. The follow-up HPV tests of the H-SIL patients were consistently negative as to cytological and colposcopical findings and no relapse was observed. At one-year follow-up the ASC-H patient who had shown postoperative histological features of koilocytosis associated with CIN2 and VAIN 3 had a persistence of high-risk HPV types with negative cytological and colposcopical findings. The HPV test was positive for two years and colposcopic and histological findings of VAIN degree 2 were revealed three years after surgery. Following vaginal laser CO2 vaporization the subsequently cytological and colposcopic checks were negative as was molecular detection of HPV.
Follow-up colposcopy, cytology and molecular detection of HPV is recommended in all verrucous carcinoma patients since carcinogenic HPV DNA detection could represent a valuable diagnostic tool as an adjunct to cytology, for monitoring HPV infections with transforming potential.
疣状癌是宫颈高分化鳞状细胞癌的一种罕见变体。高危型人乳头瘤病毒（HPV）感染是女性生殖道上皮内瘤变和浸润性肿瘤的主要原因，但疣状癌的病因仍不清楚。本研究的目的是评估宫颈疣状癌中HPV的存在情况，并调查高危型HPV在随访中的持续存在情况及其作用。
观察了3例细胞学不典型的患者。所有患者均接受了细胞学和阴道镜检查，随后进行了直接活检。采用杂交捕获II微孔板法对手术前的低危和高危型HPV进行分子检测。在随访期间每年进行HPV检测。
细胞学检查结果显示，1例为非典型鳞状细胞“不能排除高级别病变”（ASC-H），2例为高级别鳞状上皮内病变（H-SIL）。HPV检测发现了高危型HPV。阴道镜检查结果显示宫颈有外生性病变。组织学检查显示，根据国际妇产科联盟（FIGO）分类，每例均为高分化I期疣状癌。根治性子宫切除术后，术后过程顺利。平均随访时间为4.6年。H-SIL患者的随访HPV检测在细胞学和阴道镜检查结果方面始终为阴性，未观察到复发。在1年随访时，ASC-H患者术后显示有与CIN2和VAIN 3相关的挖空细胞组织学特征，高危型HPV持续存在，细胞学和阴道镜检查结果为阴性。HPV检测连续两年呈阳性，术后三年发现有2级VAIN的阴道镜和组织学表现。经阴道二氧化碳激光汽化术后，随后的细胞学和阴道镜检查均为阴性，HPV分子检测也为阴性。
建议对所有疣状癌患者进行随访阴道镜检查、细胞学检查和HPV分子检测，因为致癌性HPV DNA检测作为细胞学的辅助手段，可能是监测具有转化潜能的HPV感染的一种有价值的诊断工具。
