Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea.
In Vivo. 2024 Nov-Dec;38(6):3050-3058. doi: 10.21873/invivo.13789.
BACKGROUND/AIM: Pleomorphic high-grade squamous intraepithelial lesions (PHSILs) of the uterine cervix are characterized by strikingly pleomorphic and enlarged nuclei with brisk mitotic activity. The aim of this study was to analyze the clinical outcomes of patients with PHSIL.
Clinical data were collected from the electronic medical records of 44 patients with PHSIL.
The patients' mean age was 52.1 years. The initial cytological diagnosis was HSIL in 43.2% of patients. High-risk human papillomavirus was detected in 89.5% of patients. The human papillomavirus type was not predominated by one specific type. The patients were treated with conization alone or with conization with subsequent hysterectomy. Two cases of squamous cell carcinoma coexisting with PHSIL, and one case of adenoid basal carcinoma were detected among the surgical specimens. Follow-up cytology revealed negative results for intraepithelial lesions in all patients, except for one patient who experienced recurrent PHSIL 41 months after hysterectomy and underwent laser ablation.
The incidence rates of concurrent squamous cell carcinoma (4.5%) and recurrence (2.3%) in our PHSIL cohort were lower than those previously reported in patients with conventional HSIL. Our findings suggest that pleomorphic nuclear change alone in PHSIL was not associated with worse clinical outcomes than conventional HSIL and support the notion that PHSIL does not require more aggressive clinical management than conventional HSIL. However, close follow-up with cytological examination may be necessary to determine the potential risk of recurrence.
背景/目的：宫颈多形性高级别鳞状上皮内病变（PHSIL）的特征是细胞核明显多形性和增大，有活跃的有丝分裂活动。本研究旨在分析 PHSIL 患者的临床结局。
从 44 例 PHSIL 患者的电子病历中收集临床数据。
患者的平均年龄为 52.1 岁。初始细胞学诊断为 HSIL 的占 43.2%。89.5%的患者检测到高危型人乳头瘤病毒。人乳头瘤病毒类型没有一种特定类型占主导地位。患者接受单纯锥切或锥切后子宫切除术治疗。在手术标本中发现 2 例 PHSIL 合并鳞状细胞癌，1 例腺样基底细胞癌。随访细胞学检查显示，除 1 例患者在子宫切除术后 41 个月复发 PHSIL 并接受激光消融治疗外，所有患者的上皮内病变均为阴性。
我们的 PHSIL 队列中同时发生鳞状细胞癌（4.5%）和复发（2.3%）的发生率低于传统 HSIL 患者的报道。我们的研究结果表明，与传统 HSIL 相比，PHSIL 中单纯的多形性核改变与更差的临床结局无关，并支持 PHSIL 不需要比传统 HSIL 更积极的临床管理的观点。然而，需要通过细胞学检查密切随访以确定复发的潜在风险。
