Haefner H K, Tate J E, McLachlin C M, Crum C P
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor.
Hum Pathol. 1995 Feb;26(2):147-54. doi: 10.1016/0046-8177(95)90030-6.
Recent studies suggest that subsets of vulvar intraepithelial neoplasia (VIN) may be distinguished based on morphological presentation, the presence or absence of human papillomavirus (HPV) nucleic acids, and patient age. We analyzed 65 VIN lesions, including 15 with associated squamous cell carcinoma, to determine the relationship between pathological parameters associated with common types of VIN (multinucleation, koilocytosis, verruco-papillary morphology, diffuse atypia), rarer variants (differentiation, basal atypia), patient age, and papillomavirus nucleic acids. For all lesions higher mean ages were observed in patients with lesions that were associated with cancer and with well differentiated VIN variants with basal atypia only. A strong negative correlation with HPV nucleic acids was observed for differentiated variants with basal atypia (P = .002). In the common or "classic" VIN group patients with lesions with koilocytotic atypia, multinucleation, and verruco-papillary morphology were generally younger. However, no parameter or group of parameters defined a subset of patients with a significantly lower mean age or lesions with a higher index of HPV nucleic acids. Three of six lesions of lichen sclerosus (LS)-associated VIN, including one involving invasive carcinoma in elderly women, contained HPV nucleic acids; all three lesions exhibited the features of classic VIN. The finding of HPV across a broad age range suggests that this virus may play a role in vulvar neoplasia at any point in life. The direct demonstration of HPV nucleic acids within three LS-associated VINs is intriguing because it links two distinct risk factors to the same neoplasm.
近期研究表明，可根据形态学表现、人乳头瘤病毒（HPV）核酸的有无及患者年龄来区分外阴上皮内瘤变（VIN）的亚型。我们分析了65例VIN病变，其中15例伴有鳞状细胞癌，以确定与常见类型VIN（多核、挖空细胞、疣状乳头形态、弥漫性异型性）、罕见变异型（分化、基底异型性）、患者年龄及乳头瘤病毒核酸相关的病理参数之间的关系。对于所有病变，仅在伴有癌症的病变以及仅具有基底异型性的高分化VIN变异型患者中观察到较高的平均年龄。对于具有基底异型性的分化变异型，观察到与HPV核酸呈强负相关（P = 0.002）。在常见或“经典”VIN组中，具有挖空细胞异型性、多核及疣状乳头形态病变的患者通常较年轻。然而，没有任何参数或参数组能明确界定出平均年龄显著较低或HPV核酸指数较高的患者亚组。6例硬化性苔藓（LS）相关VIN病变中有3例含有HPV核酸，其中1例累及老年女性的浸润性癌；所有3例病变均表现出经典VIN的特征。在较宽年龄范围内发现HPV表明该病毒可能在生命中的任何阶段对外阴肿瘤形成起作用。在3例LS相关VIN中直接检测到HPV核酸很有意思，因为它将两个不同的危险因素与同一肿瘤联系起来。
