肛管乳头状未成熟化生：一种可模仿高级别病变的低级别病变。

Papillary Immature Metaplasia of the Anal Canal: A Low-grade Lesion That Can Mimic a High-grade Lesion.

作者信息

Roberts Jennifer M, Cornall Alyssa M, Ekman Deborah, Law Carmella, Poynten I Mary, Jin Fengyi, Hillman Richard J, Templeton David J, Tabrizi Sepehr N, Garland Suzanne M, Thurloe Julia K, Grulich Andrew E, Farnsworth Annabelle

机构信息

*Douglass Hanly Moir Pathology ∥St Vincent's Hospital ¶The Kirby Institute, UNSW Australia #Western Sydney Sexual Health Centre, University of Sydney **RPA Sexual Health, Sydney Local Health District, Sydney, NSW †Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital ‡Murdoch Childrens Research Institute §Department of Obstetrics and Gynaecology, University of Melbourne, Vic., Australia.

出版信息

Am J Surg Pathol. 2016 Mar;40(3):348-53. doi: 10.1097/PAS.0000000000000549.

DOI:10.1097/PAS.0000000000000549

PMID:26551619

Abstract

In a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia, we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples. PIM has previously been described in the cervix, but not in the anal canal. PIM is a form of exophytic low-grade squamous intraepithelial lesion (eLSIL) also known as condyloma. In contrast to the maturing keratinocytes and koilocytosis seen in conventional eLSIL, the slender papillary structures of PIM have a surface population of immature squamous cells. In our anal samples PIM was characterized by close proximity to conventional eLSIL, was negative for p16 (p16) expression, and revealed the presence of a single low-risk HPV genotype (either 6 or 11) in laser capture microdissected lesions. The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population. In routine practice, awareness of anal canal PIM and p16 immunostaining will prevent this. Further study of the natural history of anal canal PIM is needed.

摘要

在澳大利亚悉尼对男同性恋者进行的一项关于肛门人乳头瘤病毒（HPV）感染及HPV相关病变的自然史研究中，我们在肛门活检样本中识别出15例乳头状未成熟化生（PIM）。PIM此前已在宫颈中被描述，但未见于肛管。PIM是一种外生性低级别鳞状上皮内病变（eLSIL），也称为湿疣。与传统eLSIL中所见的成熟角质形成细胞和挖空细胞不同，PIM的细长乳头状结构有一层未成熟鳞状细胞表面群体。在我们的肛门样本中，PIM的特征是紧邻传统eLSIL，p16（p16）表达阴性，并且在激光捕获显微切割病变中显示存在单一低风险HPV基因型（6型或11型）。识别PIM的临床意义在于防止因细胞群体形态不成熟而误诊为高级别鳞状上皮内病变（肛门癌的假定前驱病变）。在常规实践中，了解肛管PIM和p16免疫染色可避免这种情况。需要对肛管PIM的自然史进行进一步研究。