Junge J, Poulsen H, Horn T, Hørding U, Lundvall F
Department of Pathology, Hvidovre Hospital University of Copenhagen, Denmark.
APMIS. 1997 Dec;105(12):963-71.
Sixty-one women with vulvar dysplasia or carcinoma in situ were treated with local laser excision of the initial lesion and of the recurrences, and followed at intervals of from 3 increasing to 12 months. Recurrences were observed in 16 (26%) patients. No case of invasive carcinoma was seen. Patients with recurrences were significantly younger than those without (P < 0.02, median age 42.5 and 54 years, respectively). The resection borders were significantly more often involved in the initial lesions in the group with recurrences (36%) than in the group without (9%) (P < 0.014). All lesions were classified according to the WHO (mild, moderate, severe dysplasia or carcinoma in situ) and Toki et al. (1991) (warty, basaloid, combined warty/basaloid or mixed (warty, basaloid and simple). No pure types of Toki (1991) could be demonstrated. There were no differences regarding recurrences in any of these groups. HPV DNA was detected in the initial lesions by PCR in 50/56 (89%) (44 with HPV type 16 and 6 with HPV type 33) and by ISH in 23/61 (38%). The same type of HPV could be demonstrated in all first recurrences except in two, where HPV types 33 was shown in specimens harboring HPV type 16 in the initial lesions. In one of these cases, HPV type 16 could again be demonstrated in the second and final recurrence. In no specimen was more than one type of HPV detected. The results indicate that the most important parameter in predicting the recurrence of vulvar dysplasia or carcinoma in situ is the involvement of the resection borders. The location of the lesion, the degree and type of dysplasia, and the type of HPV seem to play a minor role. Local excision and subsequent intensive control with removal of any visible new lesion probably prevents development of vulvar invasive carcinoma.
61例患有外阴发育异常或原位癌的女性接受了初始病变及复发病变的局部激光切除术，并每隔3个月（后增至12个月）进行随访。16例（26%）患者出现复发。未观察到侵袭性癌病例。复发患者明显比未复发患者年轻（P<0.02，中位年龄分别为42.5岁和54岁）。复发组初始病变的切除边缘受累频率（36%）明显高于未复发组（9%）（P<0.014）。所有病变均根据世界卫生组织（轻度、中度、重度发育异常或原位癌）以及Toki等人（1991年）（疣状、基底样、疣状/基底样混合型或混合型（疣状、基底样和单纯型））进行分类。未发现Toki（1991年）所定义的纯类型。这些组中的任何一组在复发方面均无差异。通过PCR在50/56例（89%）的初始病变中检测到HPV DNA（44例为HPV 16型，6例为HPV 33型），通过原位杂交在23/61例（38%）中检测到。除2例之外，所有首次复发中均可检测到与初始病变相同类型的HPV，这2例初始病变中为HPV 16型的标本在复发时显示为HPV 33型。在其中1例病例中，HPV 16型在第二次及最终复发时再次被检测到。在任何标本中均未检测到超过一种类型的HPV。结果表明，预测外阴发育异常或原位癌复发的最重要参数是切除边缘是否受累。病变位置、发育异常的程度和类型以及HPV类型似乎起次要作用。局部切除并随后通过切除任何可见的新病变进行强化控制可能会预防外阴侵袭性癌的发生。
