Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Br J Cancer. 2013 Oct 15;109(8):2259-65. doi: 10.1038/bjc.2013.563. Epub 2013 Sep 24.
Vulvar cancer is the fourth most common gynaecological malignancy, with an annual incidence of 2 out of 100,000 women. Although most cases of early stage vulvar cancer have a good prognosis, recurrence and rapid tumour progression can occur. We investigated the prevalence of spindle cell morphology in vulvar cancer and its association with survival.
This retrospective cohort study included 108 patients with primary vulvar squamous cell carcinoma who were treated at the Leiden University Medical Center during 2000-2009. Paraffin-embedded tissue was examined for the presence of spindle cell morphology. Survival and histology data were compared between cases with spindle and without spindle cell morphology.
Twenty-two (20%) tumours showed spindle cells infiltrating the stromal tissue. All spindle cell tumours were human papillomavirus (HPV) negative. Spindle cell morphology was strongly associated with poor prognosis and with a high risk of lymph node involvement at the time of diagnosis (relative risk 2.26 (95% CI 1.47-3.47)). Five-year disease-specific survival was lower in patients with vs without spindle cell morphology (45.2% vs 79.7%, respectively; P=0.00057).
Vulvar spindle cell morphology occurs frequently and seems to develop through the non-HPV pathway. It is associated with a worse prognosis than conventional vulvar squamous cell carcinoma.
外阴癌是第四种常见的妇科恶性肿瘤，年发病率为每 10 万人中有 2 例。尽管大多数早期外阴癌患者预后良好，但仍可能出现复发和肿瘤快速进展。我们研究了外阴癌中梭形细胞形态的流行情况及其与生存的关系。
这是一项回顾性队列研究，纳入了 2000 年至 2009 年在莱顿大学医学中心治疗的 108 例原发性外阴鳞状细胞癌患者。对石蜡包埋组织进行梭形细胞形态检查。对有和无梭形细胞形态的病例进行生存和组织学数据比较。
22 例（20%）肿瘤存在浸润间质组织的梭形细胞。所有梭形细胞瘤均为人乳头瘤病毒（HPV）阴性。梭形细胞形态与不良预后以及诊断时淋巴结受累的高风险密切相关（相对风险 2.26（95%CI 1.47-3.47））。与无梭形细胞形态的患者相比，有梭形细胞形态的患者 5 年疾病特异性生存率较低（分别为 45.2%和 79.7%；P=0.00057）。
外阴梭形细胞形态较为常见，似乎通过非 HPV 途径发展而来。它与比传统外阴鳞状细胞癌更差的预后相关。
