Euvrard S, Chardonnet Y, Hermier C, Viac J, Thivolet J
Clinique Dermatologique, Hôpital E.-Herriot, Lyon.
Ann Dermatol Venereol. 1989;116(3):201-11.
Kidney transplant recipients suffer in the long-term from several cutaneous disorders linked to the transplantation. We had the opportunity to observe several patients presenting with pre-epitheliomatous keratoses and cutaneous carcinomas associated with warts. We report herein on five cases that were subjected to a clinical, histological and virological study. Material and methods. Clinical and histological report. The patients were referred to use by the Kidney Transplantation Department of the Ed. Herriot Hospital (Lyon). They were examined clinically by one of us (S.E.). Virological studies. These were performed on warts, keratoses, keratoacanthomas and squamous cell carcinomas. Human papillomavirus (HPV) antigen was detected by indirect immunofluorescence using rabbit antibodies raised against group-specific HPV antigen; viral DNA was detected by in situ molecular hybridization using biotinylated probes of types 1a, 2a, 16, 18 in all cases and type 5 in 14 lesions under stringent conditions. DNA-DNA hybrids were revealed by an alkaline phosphatase enzymatic system.
(a) Clinical data are summarized in table I (see fig. 1-5). (b) Histological examination (fig. 6-9) showed either unequivocal squamous-cell carcinoma or keratoacanthoma . The overall architecture of the lesions was reminiscent of keratoacanthoma; however the lower limit was frequently not sharply demarcated; in that area, cells contained large basophilic nuclei exhibiting atypical features and numerous mitoses. The majority of lesions had an histological appearance reminiscent of warts (table III), with upper epidermal keratinocytes being vacuolized and containing basophilic (c) The results of virological studies (fig. 10-13) are summarized in table III. HPV group specific antigen was detected merely in 5 out of 33 lesions; in contrast, in situ molecular hybridization showed that 25 out of 33 lesions contained HPV DNA, with 14 of them containing the potentially oncogenic types 16 and 18. Only 2 lesions were positive with the prove HPV 5. Discussion. The overall incidence of cancers in Kidney transplant recipients (3 p. 100) is about 100 times higher than in control populations (17). Cutaneous carcinomas account for about 50 p. 100 of cancers. This incidence increases with time after transplantation and sun-exposure. The delay on onset of cutaneous malignancies is relatively long (4 to 7 years) (6,7) and becomes longer with a decreasing age of the patients at the time of transplantation, as can be noted in our cases. Apart from Blohme (1), most authors have reported a prevalence of squamous over basal-cell carcinoma. None of our patients presented basal-cell carcinoma.(ABSTRACT TRUNCATED AT 400 WORDS)
肾移植受者长期患有多种与移植相关的皮肤疾病。我们有机会观察到数例出现上皮瘤前角化病以及与疣相关的皮肤癌的患者。在此，我们报告5例接受临床、组织学及病毒学研究的病例。材料与方法。临床及组织学报告。这些患者由里昂埃迪·赫里奥特医院肾脏移植科转诊至我们处。由我们其中一人（S.E.）进行临床检查。病毒学研究。对疣、角化病、角化棘皮瘤及鳞状细胞癌进行此项研究。使用针对人乳头瘤病毒（HPV）群特异性抗原的兔抗体，通过间接免疫荧光检测HPV抗原；在所有病例中，使用1a、2a、16、18型生物素化探针，在14个病变中使用5型生物素化探针，在严格条件下通过原位分子杂交检测病毒DNA。通过碱性磷酸酶酶系统显示DNA - DNA杂交体。
（a）临床数据总结于表I（见图1 - 5）。（b）组织学检查（图6 - 9）显示为明确的鳞状细胞癌或角化棘皮瘤。病变的整体结构让人联想到角化棘皮瘤；然而其下限通常界限不清；在该区域，细胞含有大的嗜碱性核，呈现非典型特征且有大量有丝分裂。大多数病变的组织学外观让人联想到疣（表III），表皮上层角质形成细胞空泡化并含有嗜碱性物质。（c）病毒学研究结果（图10 - 13）总结于表III。在33个病变中仅5个检测到HPV群特异性抗原；相比之下，原位分子杂交显示33个病变中有25个含有HPV DNA，其中14个含有潜在致癌的16型和18型。仅2个病变对HPV 5型探针呈阳性。讨论。肾移植受者癌症的总体发生率（3/100）比对照人群（17）高约100倍。皮肤癌约占癌症的50%。这种发生率随移植后时间及阳光暴露而增加。皮肤恶性肿瘤发病的延迟相对较长（4至7年）（6,7），并且随着移植时患者年龄的降低而变长，正如我们病例中所观察到的。除了布洛姆（1）之外，大多数作者报告鳞状细胞癌的患病率高于基底细胞癌。我们的患者均未出现基底细胞癌。（摘要截选至400字）
