Syrjänen S M, von Krogh G, Syrjänen K J
Department of Pathology, University of Kuopio, Finland.
Genitourin Med. 1989 Aug;65(4):216-24. doi: 10.1136/sti.65.4.216.
A series of 128 biopsy specimens from anal condylomas in 73 homosexual or bisexual and 38 heterosexual men (mean (SD) age 31.8 (9.6) years) were subjected to histological assessment and human papillomavirus (HPV) typing by in situ DNA hybridisation with 35S-labelled HPV 6, 11, 16, 18, 31, and 33 probes. Most patients were also tested serologically for antibodies to human immunodeficiency virus (HIV). As evaluated on light microscopy, most (74%, 95/128) of the lesions were exophytic (papillary) acuminate warts, 15% (19) were flat, and 11% (14) were pigmented papulous lesions. No signs of anal intraepithelial neoplasia (AIN) were seen in 70% (90) of the 128 biopsy specimens (NAIN), 27% (35) were classified as showing AIN I, and another 2% (three) as AIN II. AIN was significantly (p less than 0.05) more often associated with papulous lesions, only 43% (6/14) of which showed NAIN compared with 72% (68/98) of acuminate condylomas. The duration of disease was directly related to the presence and severity of AIN in the lesions; thus in 47 lesions that had been present for more than 12 months, NAIN was found in 31 (66%), AIN I in 14 (30%), and AIN II in two (4%). HPV DNA of at least one of the six types tested for was detected in 109/125 (87%) lesions. HPV 6 and HPV 11 were the two most common types, comprising 57% (62) and 37% (40), respectively, of the 109 HPV DNA positive cases. Only seven (6%) biopsy specimens were associated with any of HPV types 16, 18, 31, or 33, which carry a high risk of potential malignant transformation. No association was found between sexual preferences of patients and the incidence of any of the various HPV types. Neither did the distribution of the various HPV types differ between men with antibody to HIV and those without antibody. All the men with antibody to HIV were homosexual or bisexual. On microscopy, 93% (38) of 41 lesions containing HPV 11 and 75% (48/64) of HPV 6 lesions were of the acuminate wart type; in comparison, the remaining 16 HPV 6 lesions were equally either flat or papulous (eight, 13% each). Of the 64 HPV 6 and 41 HPV 11 associated lesions, 73% (47) and 63% (26), respectively, were classified as NAIN. Only two lesions were associated with HPV 16, and both showed mild dysplasia. On the other hand, two HPV 6 induced lesions were associated with AIN II. No differences were found between HPV 6 and HPV 11 in duration of disease; (39%, and 27% respectively, had been present for more than 12 months). The results showed that overt anal wart disease was associated with HPV types 6 and 11 in most cases. Although HPV types considered as being of higher oncogenic potential were detected relatively rarely, the associated AIN in a relatively high proportion (31% 32/105) of HPV 6 or 11 induced lesions indicated that a malignant potential, even for HPV 11 associated anal warts, cannot be excluded.
对73名男同性恋或双性恋男性及38名异性恋男性（平均（标准差）年龄31.8（9.6）岁）的128份肛门尖锐湿疣活检标本进行了组织学评估，并通过与35S标记的人乳头瘤病毒（HPV）6、11、16、18、31和33探针进行原位DNA杂交进行HPV分型。大多数患者还进行了血清学检测以检测抗人免疫缺陷病毒（HIV）抗体。根据光学显微镜评估，大多数（74%，95/128）病变为外生性（乳头状）尖锐湿 疣，15%（19个）为扁平状，11%（14个）为色素沉着性丘疹病变。在128份活检标本中的70%（90个）未发现肛门上皮内瘤变（AIN）迹象（无AIN），27%（35个）被分类为显示AIN I，另有2%（3个）为AIN II。AIN与丘疹病变显著（p<0.05）更常相关，其中只有43%（6/14）显示无AIN，而尖锐湿 疣为72%（68/98）。疾病持续时间与病变中AIN的存在和严重程度直接相关；因此，在存在超过12个月的47个病变中，31个（66%）发现无AIN，14个（30%）为AIN I，2个（4%）为AIN II。在109/125（87%）的病变中检测到至少一种所检测的六种HPV类型的HPV DNA。HPV 6和HPV 11是两种最常见的类型，分别占109例HPV DNA阳性病例的57%（62个）和37%（40个）。只有7个（6%）活检标本与具有潜在恶性转化高风险的HPV 16、18、31或33型中的任何一种相关。未发现患者的性偏好与任何HPV类型的发病率之间存在关联。在有HIV抗体的男性和无抗体的男性之间，各种HPV类型的分布也没有差异。所有有HIV抗体的男性均为同性恋或双性恋。在显微镜下，41个含有HPV 11的病变中有93%（38个）和HPV 6病变中有75%（48/64）为尖锐湿 疣类型；相比之下，其余16个HPV 6病变同样为扁平状或丘疹状（各8个，占13%）。在64个与HPV 6相关的病变和41个与HPV 11相关的病变中，分别有73%（47个）和63%（26个）被分类为无AIN。只有2个病变与HPV 16相关，且均显示轻度发育异常。另一方面，2个由HPV 6引起的病变与AIN II相关。在疾病持续时间方面，HPV 6和HPV 11之间未发现差异；（分别有39%和27%存在超过12个月）。结果表明，大多数情况下明显的肛门疣病与HPV 6和11型相关。尽管被认为具有较高致癌潜力的HPV类型相对较少被检测到，但在相当高比例（31%，32/105）的HPV 6或11型引起的病变中存在的相关AIN表明，即使对于与HPV 11相关的肛门尖锐湿疣，也不能排除其恶性潜力。
