Fujii T, Crum C P, Winkler B, Fu Y S, Richart R M
Obstet Gynecol. 1984 Jan;63(1):99-104.
To evaluate the reliability of diagnostic criteria for separating intraepithelial squamous lesions into low- and high-risk categories, 25 lesions of the cervix were diagnosed as flat condyloma, atypical immature metaplasia, or cervical intra-epithelial neoplasia with koilocytosis based on well-defined histologic criteria. The presumption was that flat condyloma and atypical immature metaplasia would be diploid/polyploid as compared to low-grade cervical intraepithelial neoplasia, which should be aneuploid. Using the major histologic parameter of the presence or absence of abnormal mitoses to distinguish the low- and high-risk lesions, it was found that all of five typical flat condylomas were diploid/polyploid and seven of eight atypical immature metaplastic lesions were diploid/polyploid; 11 of 13 cervical intraepithelial neoplasms with koilocytosis, however, were aneuploid. An additional histologic parameter of anisocytosis (variation in nuclear size) appeared much less reliable for segregating these lesions than the nature of the mitoses. Lesions for which ploidy values were particularly difficult to predict were extremely well-differentiated koilocytotic lesions with occasional abnormal mitoses. Whether these are true polyploid lesions in which the abnormal mitoses are a response to the virus, or whether they are very early aneuploid lesions that cannot be confirmed by microspectrophotometry, remains to be determined.
为评估将上皮内鳞状病变分为低风险和高风险类别诊断标准的可靠性，依据明确的组织学标准，对25例宫颈病变诊断为扁平湿疣、非典型未成熟化生或伴有挖空细胞的宫颈上皮内瘤变。推测扁平湿疣和非典型未成熟化生与低级别宫颈上皮内瘤变相比应为二倍体/多倍体，而低级别宫颈上皮内瘤变应为非整倍体。使用有无异常有丝分裂这一主要组织学参数来区分低风险和高风险病变，发现5例典型扁平湿疣均为二倍体/多倍体，8例非典型未成熟化生病变中有7例为二倍体/多倍体；然而，13例伴有挖空细胞的宫颈上皮内瘤变中有11例为非整倍体。与有丝分裂的性质相比，细胞大小不等（核大小变化）这一额外的组织学参数在区分这些病变方面似乎可靠性要低得多。倍体值特别难以预测的病变是具有偶尔异常有丝分裂的高分化挖空细胞病变。这些病变是真正的多倍体病变，其中异常有丝分裂是对病毒的反应，还是非常早期的非整倍体病变而无法通过显微分光光度法确认，仍有待确定。
