Núñez-Troconis José, Delgado Mariela, González Gerardo, Rivas Airiaudis, Molero Katherine
Department of Obstetrics and Gynecology, Hospital Manuel Noriega Trigo, Universidad del Zulia.
Invest Clin. 2011 Sep;52(3):268-73.
Benign melanotic lesions of the vagina are uncommon and only a few cases have been reported in the literature. A 34-year-old woman was referred because of a Vaginal Intraepithelial Neoplasia 1 biopsy result. On the gynecological examination, two different hyperpigmented areas were noted in the vagina. The colposcopic visualization of the cervix and vagina found an aceto-white lesion at the right lateral wall of the upper third of the vagina. Biopsies from three areas were taken. Histological study reported a melanosis of the vagina and HPV infection. An immunohistochemical panel of epithelial markers was performed in vaginal samples, such as Cytokeratin AE1/AE3 and epithelial membrane antigen, mesenchymal marker: vimentin; melanocytic makers: protein S-100 and HMB45 (Human Melanoma Black); proliferating cell marker: proliferating cell nuclear antigen (PCNA), and P-53 oncoprotein. High Risk (16, 18, 31, 45) and Low Risk (6, 11) HPV types were studied by In Situ Hybridization using the same vaginal samples. CK, EMA and Vimentin were 2+. Melanocytic markers, HMB45 and S100, and PCNA were 1+ in basal cell layer. P-53 was negative. The melanotic tissue and acetowhite lesion were positives to HPV Types 6,11. In conclusion, melanosis of the vagina is a uncommon benign pathology. Usually, melanosis is present in women over 40 years old. We present a case of melanosis of the vagina in a young woman infected with low-risk HPV types and review the literature.
阴道良性黑素沉着性病变并不常见，文献中仅报道过少数病例。一名34岁女性因阴道上皮内瘤变1级活检结果前来就诊。妇科检查时，在阴道内发现了两个不同的色素沉着区域。宫颈和阴道的阴道镜检查发现阴道上三分之一右侧壁有醋酸白病变。从三个区域取了活检样本。组织学研究报告为阴道黑素沉着和人乳头瘤病毒（HPV）感染。对阴道样本进行了上皮标志物的免疫组织化学检测，如细胞角蛋白AE1/AE3和上皮膜抗原、间充质标志物波形蛋白、黑素细胞标志物S-100蛋白和HMB45（人黑色素瘤黑色抗体）、增殖细胞标志物增殖细胞核抗原（PCNA）以及P-53癌蛋白。使用相同的阴道样本通过原位杂交研究了高危（16、18、31、45型）和低危（6、11型）HPV类型。细胞角蛋白、上皮膜抗原和波形蛋白呈2+。黑素细胞标志物HMB45和S100以及增殖细胞核抗原在基底细胞层呈1+。P-53为阴性。黑素沉着组织和醋酸白病变对HPV 6、11型呈阳性。总之，阴道黑素沉着是一种罕见的良性病变。通常，黑素沉着见于40岁以上女性。我们报告了一例感染低危HPV类型的年轻女性阴道黑素沉着病例并对文献进行了综述。
