子宫颈柱状上皮不成熟化生的研究进展和更新：一种低级别鳞状上皮内病变的特殊亚型，提出了一种可能的起源细胞。

A Review and Update on Papillary Immature Metaplasia of the Uterine Cervix: A Distinct Subset of Low-Grade Squamous Intraepithelial Lesion, Proposing a Possible Cell of Origin.

机构信息

From the Department of Pathology, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea (Dr Hong); the Pathology Laboratory Department of U2Bio Co. Ltd., Seoul, Korea, and Department of Hospital Pathology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea (Dr Yoo); the Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (Drs Choi and Kim); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy). Dr Yoo is currently at the Pathology Laboratory Department of U2Bio Co. Ltd., Seoul, Korea.

出版信息

Arch Pathol Lab Med. 2018 Aug;142(8):973-981. doi: 10.5858/arpa.2017-0267-OA. Epub 2018 Apr 13.

DOI:10.5858/arpa.2017-0267-OA

PMID:29652189

Abstract

CONTEXT

Papillary immature metaplasia (PIM) is a known papillary cervical lesion associated with low-risk human papillomavirus (LR-HPV).

OBJECTIVE

To evaluate additional clinicopathologic features and the HPV genotypes of PIM and discuss the presumptive cell of origin.

DESIGN

A total of 26 PIM cases were evaluated by p16, cytokeratin (CK) 7, and CK17 immunohistochemical stainings. Human papillomavirus genotyping was performed, by using HPV DNA Chip, HPV polymerase chain reaction (PCR), and real-time PCR.

RESULTS

Histologically, PIM forms either a papillary mass (n = 21 of 26, 81%) or a slightly elevated/flat plaque (n = 5, 19%). All cases contain variable amounts of mucinous epithelia within the lesions. Koilocytosis was identified in 15 of the 26 cases (58%). Sixteen cases (61%) were associated with LR-HPV (types 6, 11, or 42), but 3 cases (12%) with high-risk (HR) HPV (16, 16/18, and 33), 2 cases (8%) with mixed LR- and HR-HPV (6/16 and 11/58), while 2 cases (8%) were negative, but p16 immunostaining showed nonblock positivity in all cases. Eight (31%) had high-grade squamous intraepithelial lesion (HSIL) in the adjacent mucosa, 4 (50%) of which showed direct continuity. Identical HPV subtypes were confirmed in separately microdissected cases from PIM and adjacent HSIL. Most lesions (n = 24, 92%) expressed CK17 (reserve cell marker) in a bottom-heavy pattern and CK7 (squamocolumnar junction [SCJ] marker) in a top-heavy pattern, while most cases of low-grade squamous intraepithelial lesion (LSIL) were negative for both markers.

CONCLUSIONS

Our results suggest that PIM is a distinct subset of LSIL showing a productive HPV infection, but PIM involves the transformation zone and is proximal to SCJ, while LSIL is mostly from ectocervix or distal to the SCJ.

摘要

背景

乳头状不成熟化生（PIM）是一种已知的与低危型人乳头瘤病毒（LR-HPV）相关的宫颈乳头状病变。

目的

评估 PIM 的其他临床病理特征和 HPV 基因型，并讨论推定的细胞起源。

设计

通过 p16、细胞角蛋白（CK）7 和 CK17 免疫组织化学染色评估总共 26 例 PIM 病例。通过 HPV DNA 芯片、HPV 聚合酶链反应（PCR）和实时 PCR 进行 HPV 基因分型。

结果

组织学上，PIM 形成乳头状肿块（26 例中的 21 例，81%）或略微隆起/扁平斑块（26 例中的 5 例，19%）。所有病例的病变内均有不同数量的黏液性上皮。在 26 例中有 15 例（58%）发现挖空细胞。16 例（61%）与 LR-HPV（6、11 或 42 型）相关，但 3 例（12%）与 HR-HPV（16、16/18 和 33 型）相关，2 例（8%）与 LR-和 HR-HPV 混合（6/16 和 11/58）相关，而 2 例（8%）为阴性，但所有病例的 p16 免疫染色均显示非阻断性阳性。8 例（31%）在相邻黏膜中存在高级别鳞状上皮内病变（HSIL），其中 4 例（50%）存在直接连续性。从 PIM 和相邻 HSIL 中分别微分离的病例中证实了相同的 HPV 亚型。大多数病变（24 例，92%）表达 CK17（储备细胞标志物）呈底部沉重模式，CK7（鳞状柱状交界标志物）呈顶部沉重模式，而大多数低级别鳞状上皮内病变（LSIL）两种标志物均为阴性。