Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
Int J Dermatol. 2017 Oct;56(10):1017-1021. doi: 10.1111/ijd.13711. Epub 2017 Jul 25.
The clinical morphology of anogenital warts may vary from flat, filiform, papular, or verrucous to giant condyloma acuminatum. Clinically atypical-looking genital warts may alarm the clinician because of their suspected malignant potential, which may cause anxiety, often leading to aggressive interventions.
To study if clinically atypical-looking anogenital warts are more likely to be premalignant or malignant as compared to typical warts.
Data of 41 (37 males, 4 females) patients with anogenital warts was retrospectively analyzed. After a detailed literature review and in-house discussions, criteria for anogenital warts with typical and atypical clinical morphology were defined. Clinical photographs were independently reviewed by three dermatologists, and human papillomavirus (HPV) genotyping results, histological evaluation, and immunohistochemical analysis for p53 expression were evaluated.
Fifteen (36.6%) anogenital warts were classified as atypical by at least two of three blinded dermatologists. The histological examination showed mitotic figures in 31/41 (75.6%) specimens, dysplasia in 14/41 (44.1%) specimens, and p53 positivity in 34/41 (82.9%) specimens. There was no significant difference in the high-risk HPV genotyping (P = 0.67), frequency of dysplastic changes on histology (P = 0.19), and immunohistochemistry with p53 (P = 0.08) between clinically typical and atypical-appearing anogenital warts. Similarly, no significant difference was found in the frequency of dysplastic changes (P = 0.67) or p53 expressions (P =0.41) based on the HPV genotypes.
The atypical clinical morphology of anogenital warts may not be a marker of increased malignant potential. High-risk HPV genotypes do not have a statistically significant association with dysplasia or positive immunohistochemistry with p53.
肛门生殖器疣的临床形态可能从扁平、丝状、丘疹状或疣状到巨大尖锐湿疣不等。临床外观不典型的生殖器疣可能因其可疑的恶性潜能而引起临床医生的警惕,这可能导致焦虑,通常导致积极的干预。
研究临床外观不典型的肛门生殖器疣与典型疣相比是否更有可能具有癌前或恶性潜能。
回顾性分析了 41 例(37 名男性,4 名女性)肛门生殖器疣患者的数据。在进行详细的文献复习和内部讨论后,定义了具有典型和非典型临床形态的肛门生殖器疣的标准。三位皮肤科医生独立审查临床照片,评估 HPV 基因分型结果、组织学评估以及 p53 表达的免疫组织化学分析。
至少有两位盲法皮肤科医生将 15 例(36.6%)肛门生殖器疣归类为非典型。组织学检查显示 31/41(75.6%)标本有有丝分裂象,14/41(44.1%)标本有发育不良,34/41(82.9%)标本有 p53 阳性。高危型 HPV 基因分型(P = 0.67)、组织学上发育不良改变的频率(P = 0.19)以及 p53 的免疫组化(P = 0.08)在临床典型和外观不典型的肛门生殖器疣之间均无显著差异。同样,基于 HPV 基因型,也未发现发育不良改变(P = 0.67)或 p53 表达(P = 0.41)的频率存在显著差异。
肛门生殖器疣的非典型临床形态可能不是恶性潜能增加的标志物。高危型 HPV 基因型与发育不良或 p53 免疫组化阳性无统计学显著关联。