Crissman J D, Kessis T, Shah K V, Fu Y S, Stoler M H, Zarbo R J, Weiss M A
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202.
Hum Pathol. 1988 Dec;19(12):1387-96. doi: 10.1016/s0046-8177(88)80231-4.
Selected papillary squamous tumors of the upper aerodigestive tract (UADT) mucosa in adult patients do not have well-defined histologic criteria and the clinical behavior is poorly understood. To better characterize this spectrum of neoplasms, UADT papillary neoplasms were evaluated by routine histology, determination of cellular DNA content using Feulgen-stained tissue sections, and the typing of human papillomavirus (HPV) by in situ hybridization. Solitary papillomas were studied in two patients; there was no recurrence in either case, both had normal DNA content, and one was typed as HPV-6 while the other was typed as HPV-11. Seven adult patients with recurrent papillomatosis and at least one biopsy with dysplasia/atypia were identified (mean age at diagnosis, 13.3 years; mean age at last contact, 42.7 years). Six of seven patients had abnormal DNA cellular content in foci of epithelial atypia. In all biopsies evaluated, the papillomas of the seven patients were consistently typed as either HPV-6 or HPV-11. Six patients with malignant papillary neoplasms also had abnormal DNA cellular content, but none revealed evidence of HPV type 6, 11, 16, or 18 by in situ hybridization of tissue sections. In many of the recurrent papillomas, the degree of epithelial atypia encountered was pronounced and was commonly misdiagnosed as carcinoma in situ or papillary carcinoma. The aneuploid DNA content of these foci of atypia reflected the abnormal cellular appearance and partially explained the overdiagnosis of malignancy. However, none of the seven patients were treated for malignant disease and none progressed to invasive carcinoma, with an average follow-up period of almost 30 years. We conclude that histologic and cytologic atypia in HPV-containing papillomatosis may be appreciable. The aneuploid DNA content may represent premalignant conditions and the patient may be at an increased risk for the subsequent development of squamous cancer. However, none of the seven patients with recurrent papillomatosis developed any evidence of malignancy. In addition, none of the patients with papillary carcinomas had previous recurrent papillomatosis.
成年患者上呼吸消化道（UADT）黏膜的某些乳头状鳞状肿瘤没有明确的组织学标准，其临床行为也知之甚少。为了更好地描述这类肿瘤的特征，我们通过常规组织学检查、使用福尔根染色组织切片测定细胞DNA含量以及原位杂交对人乳头瘤病毒（HPV）进行分型，对UADT乳头状肿瘤进行了评估。对两名患者的孤立性乳头状瘤进行了研究；两例均无复发，DNA含量均正常，其中一例HPV分型为6型，另一例为11型。确定了7例患有复发性乳头状瘤病且至少有一次活检显示发育异常/非典型增生的成年患者（诊断时平均年龄13.3岁；最后一次随访时平均年龄42.7岁）。7例患者中有6例在上皮非典型增生灶中细胞DNA含量异常。在所有评估的活检中，7例患者的乳头状瘤均一致分型为HPV-6或HPV-11。6例恶性乳头状肿瘤患者的细胞DNA含量也异常，但组织切片原位杂交未发现HPV 6、11、16或18型的证据。在许多复发性乳头状瘤中，所遇到的上皮非典型增生程度明显，常被误诊为原位癌或乳头状癌。这些非典型增生灶的非整倍体DNA含量反映了细胞外观异常，部分解释了恶性肿瘤的过度诊断。然而，这7例患者均未接受恶性疾病治疗，也无进展为浸润性癌，平均随访期近30年。我们得出结论，含HPV的乳头状瘤病中的组织学和细胞学非典型增生可能较为明显。非整倍体DNA含量可能代表癌前状态，患者随后发生鳞状癌的风险可能增加。然而，7例复发性乳头状瘤病患者均未出现任何恶性肿瘤证据。此外，乳头状癌患者均无先前的复发性乳头状瘤病。
