Ogunbiyi O A, Scholefield J H, Robertson G, Smith J H, Sharp F, Rogers K
Department of Surgery, Northern General Hospital, Sheffield, United Kingdom.
Obstet Gynecol. 1994 Feb;83(2):212-6.
To test the hypothesis that women with invasive vulvar cancer are at high risk of developing human papillomavirus (HPV)-associated anal squamous neoplasia.
Forty women (median age 54.5 years; range 25-86) who were being treated or had been treated for invasive vulvar cancer and who had not had radiotherapy to the pelvis or anogenital region underwent anal microendoscopy and biopsy. A second group of 80 women who were similar in age to the study group and had no history of anogenital HPV infection or neoplasia formed the control group. The polymerase chain reaction was used to detect HPV 16 DNA in the vulvar and anal tissue samples from 33 patients in the study group and in the anal biopsies of all controls.
A histologic diagnosis of anal HPV infection or squamous neoplasia was made in 19 of 40 biopsies (47.5%) in the study group. These diagnoses consisted of one HPV, two anal squamous intraepithelial lesions (SIL) grade I, 15 and SIL grade III (four of which were associated with invasive anal cancers), and one invasive cancer in the absence of anal SIL. Human papillomavirus 16 DNA was detected in 16 of 33 (48.5%) of anal and 25 of 33 (75%) of vulvar biopsies. In addition, HPV 16 was detected in both the anal and vulvar samples in 13 of 16 cases (81%) of anal SIL III and invasive anal squamous cancer. No evidence of anal SIL was found in the controls, and HPV 16 DNA was identified in only 11 (13.7%) of the anal biopsies in this group.
This study provides further evidence for the etiologic relation between genital and anal squamous neoplasia. Furthermore, it shows that women with vulvar cancer are at high risk of having or developing HPV-associated anal neoplasia, particularly in younger patients (P = .0006; 95% confidence interval 12-34). Routine anal examination should be performed in patients with invasive vulvar cancer.
检验浸润性外阴癌女性发生人乳头瘤病毒（HPV）相关肛门鳞状上皮瘤变风险较高这一假设。
40名正在接受或曾接受浸润性外阴癌治疗且未接受过盆腔或肛门生殖器区域放疗的女性（中位年龄54.5岁；范围25 - 86岁）接受了肛门微型内镜检查和活检。另一组80名年龄与研究组相似且无肛门生殖器HPV感染或瘤变病史的女性作为对照组。采用聚合酶链反应检测研究组33例患者外阴和肛门组织样本以及所有对照组肛门活检样本中的HPV 16 DNA。
研究组40例活检中有19例（47.5%）作出肛门HPV感染或鳞状上皮瘤变的组织学诊断。这些诊断包括1例HPV感染、2例I级肛门鳞状上皮内病变（SIL）、15例III级SIL（其中4例与浸润性肛门癌相关）以及1例无肛门SIL的浸润性癌。33例肛门活检中有16例（48.5%）以及33例外阴活检中有25例（75%）检测到HPV 16 DNA。此外，在16例III级肛门SIL和浸润性肛门鳞状癌病例中有13例（81%）的肛门和外阴样本中均检测到HPV 16。对照组未发现肛门SIL证据，该组仅11例（13.7%）肛门活检中鉴定出HPV 16 DNA。
本研究为生殖器和肛门鳞状上皮瘤变之间的病因学关系提供了进一步证据。此外，研究表明外阴癌女性发生或发展为HPV相关肛门瘤变的风险较高，尤其是年轻患者（P = 0.0006；95%置信区间12 - 34）。浸润性外阴癌患者应进行常规肛门检查。
