Pakharukova M I, Yushkov B G
Institute of Immunology and Physiology, Yekaterinburg, Russia.
Y.B. Beikin Clinical and Diagnostic Center, Yekaterinburg, Russia.
Arkh Patol. 2025;87(3):26-32. doi: 10.17116/patol20258703126.
Squamous cell carcinomas of the vulva are divided into human papillomavirus (HPV)-associated and HPV-independent. There is a need to determine the most effective methods for determining the HPV status of a tumor. Differences in the morphological structure of carcinomas have been shown, but the histological type of tumor does not fully reflect the differences in cell size for understanding the mechanisms of carcinogenesis.
To compare the morphometric and histological characteristics of HPV-associated and HPV-independent vulvar carcinomas and to calculate the specificity of histological, immunohistochemical methods and detection of viral DNA in establishing the HPV status of the tumor.
The study retrospectively included 74 patients. HPV typing was performed by real-time PCR, expression of p16 and p53 was determined by immunohistochemical method. The total area of tumor cells, the area of the cytoplasm and the nucleus were measured, and the nuclear-cytoplasmic ratio was calculated.
HPV-independent carcinomas are predominantly keratinizing (94.3%). HPV-associated carcinomas are of basaloid histotype in 57.1% of cases and keratinizing in 42.9%. (42.9%). HPV-associated tumor cells are smaller (Me 223.89) compared to HPV-independent carcinoma cells (Me 525.95). The nuclear-cytoplasmic ratio was higher in HPV-associated carcinomas (Me 0.46 vs 0.18). The specificity of determining HPV status using histological characteristics of the tumor was 80.65%, immunohistochemical method - 96.36%, detection of viral DNA in the tumor - 75.47%.
A smaller cell area and a nuclear-cytoplasmic ratio shift toward the nucleus characterize HPV-associated carcinomas. With HPV-independent carcinogenesis, tumor cells more often retain the ability to differentiate and mature the epithelium. Immunohistochemical determination of p16 and p53 expression is a more accurate method for determining the HPV status of vulvar carcinoma.
外阴鳞状细胞癌分为人乳头瘤病毒（HPV）相关型和HPV非相关型。需要确定检测肿瘤HPV状态的最有效方法。已显示出癌的形态结构存在差异，但肿瘤的组织学类型并不能完全反映细胞大小差异，以了解致癌机制。
比较HPV相关型和HPV非相关型外阴癌的形态计量学和组织学特征，并计算在确定肿瘤HPV状态时组织学、免疫组化方法及病毒DNA检测的特异性。
本研究回顾性纳入74例患者。通过实时PCR进行HPV分型，采用免疫组化方法测定p16和p53的表达。测量肿瘤细胞的总面积、细胞质面积和细胞核面积，并计算核质比。
HPV非相关型癌主要为角化型（94.3%）。HPV相关型癌57.1%为基底样组织学类型，42.9%为角化型。与HPV非相关型癌细胞（中位数525.95）相比，HPV相关型肿瘤细胞较小（中位数223.89）。HPV相关型癌的核质比更高（中位数0.46对0.18）。利用肿瘤组织学特征确定HPV状态的特异性为80.65%，免疫组化方法为96.36%，肿瘤中病毒DNA检测为75.47%。
细胞面积较小和核质比向细胞核偏移是HPV相关型癌的特征。在HPV非相关致癌过程中，肿瘤细胞更常保留上皮分化和成熟的能力。免疫组化测定p16和p53表达是确定外阴癌HPV状态的更准确方法。
