Kurman R J, Toki T, Schiffman M H
Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Am J Surg Pathol. 1993 Feb;17(2):133-45. doi: 10.1097/00000478-199302000-00005.
In a previous study, we described an elevated prevalence of human papillomavirus (HPV) in two specific types of squamous cell carcinoma of the vulva designated basaloid carcinoma (BC) and warty carcinoma (WC) compared with the conventional type of keratinizing squamous cell carcinoma (KSC). To determine whether there were other differences in their clinical presentation or behavior, we examined 100 cases of squamous cell carcinoma of the vulva classified as BC (28 cases), WC (seven cases), and KSC (65 cases). We included only cases in which tissue adjacent to the tumor was present so that the presence of intraepithelial lesions (squamous hyperplasia, lichen sclerosus, and vulvar intraepithelial neoplasia [VIN]) could be correlated with the different types of invasive carcinomas. Microscopically, BC was characterized by a relatively uniform population of small, ovoid cells with a high nuclear-cytoplasmic ratio resembling VIN 3. Although WC was similar to typical squamous cell carcinoma, it contained many squamous cells that displayed marked nuclear pleomorphism, enlargement, atypia, and multinucleation in conjunction with cytoplasmic cavitation resembling koilocytotic atypia in intraepithelial lesions. The majority of the women with BC and WC were less than 60 years of age, and the proportion of black women was higher as compared with the women with KSC, the majority of whom were white and over 65 years of age. On crude comparison, women with BC appeared to have a survival advantage compared with women with KSC; however, through multivariate modelling, when all possible confounding variables were taken into account, there was little residual impression of a survival advantage of women with BC compared with those having KSC. Substantial differences were found among the three types of carcinoma with regard to the prevalence of adjacent intraepithelial lesions. Squamous hyperplasia was found adjacent to KSC in 54 (83%) of the 65 cases, whereas 27 (77%) of 35 cases of BC and WC had adjacent basaloid or warty VIN. These findings suggest that VIN is a precursor of BC and WC. In view of the high frequency of HPV-DNA detected in VIN and in BC and WC, the findings support the view that HPV has a role in the development of these tumors. In addition, a difference was found in the distribution of associated cervical and vaginal tumors with the three types of vulvar carcinomas.(ABSTRACT TRUNCATED AT 400 WORDS)
在之前的一项研究中，我们发现与传统的角化性鳞状细胞癌（KSC）相比，两种特定类型的外阴鳞状细胞癌，即基底样癌（BC）和疣状癌（WC）中，人乳头瘤病毒（HPV）的患病率有所升高。为了确定它们在临床表现或行为上是否存在其他差异，我们检查了100例被分类为BC（28例）、WC（7例）和KSC（65例）的外阴鳞状细胞癌病例。我们仅纳入了有肿瘤相邻组织的病例，以便上皮内病变（鳞状上皮增生、硬化性苔藓和外阴上皮内瘤变[VIN]）的存在能够与不同类型的浸润性癌相关联。显微镜下，BC的特征是相对均匀的小卵圆形细胞群体，核质比高，类似于VIN 3。虽然WC与典型的鳞状细胞癌相似，但它含有许多鳞状细胞，这些细胞显示出明显的核多形性、增大、异型性和多核化，同时伴有细胞质空泡化，类似于上皮内病变中的挖空细胞异型性。大多数BC和WC患者年龄小于60岁，与KSC患者相比，黑人女性的比例更高，KSC患者大多数是白人且年龄超过65岁。初步比较显示，BC患者与KSC患者相比似乎有生存优势；然而，通过多变量建模，当考虑所有可能的混杂变量时，与KSC患者相比，BC患者几乎没有生存优势的残留印象。在三种类型的癌中，相邻上皮内病变的患病率存在显著差异。65例KSC病例中有54例（83%）的相邻组织存在鳞状上皮增生，而35例BC和WC病例中有27例（77%）的相邻组织存在基底样或疣状VIN。这些发现表明VIN是BC和WC的前驱病变。鉴于在VIN以及BC和WC中检测到HPV-DNA的频率很高，这些发现支持HPV在这些肿瘤发生中起作用的观点。此外，在三种类型的外阴癌相关的宫颈和阴道肿瘤分布上也发现了差异。（摘要截选至400字）
