与人乳头状瘤病毒相关外阴鳞癌的临床及病理学特征

目的：探讨与人乳头状瘤病毒（ＨＰＶ）相关外阴鳞癌的临床及病理学特征。方法：对手术标本的ＨＥ染色切片进行组织学分型，应用ＰＣＲ－ＨＰＶ检测技术，并结合临床资料，对３７例外阴鳞癌的组织形态学及临床特点进行分析研究。结果：３７例中，２４例为角化鳞癌即典型鳞癌，７例为基底细胞样癌，６例为湿疣样癌。基底细胞样癌和湿疣样癌占全组病例的３５％，其ＨＰＶ的阳性检出率为８３．３％，以ＨＰＶ１６型为主，而角化鳞癌病例的ＨＰＶ检出率为０．０％。与角化鳞癌病例相比较，基底细胞样癌及湿疣样癌有以下特点：瘤周常伴有上皮内肿瘤（８４．６％，１６．７％）；发病年龄相对年轻（４７．８岁，６３．３岁）；淋巴结转移率较低（７．６％，２５．０％）；复发率较高（１２．５％，７．７％）；但复发后手术治疗效果仍较好；可伴有下生殖道其它部位的鳞状上皮病变或浸润性癌。结论：基底细胞样癌和湿疣样癌的临床及病理学特征与ＨＰＶ感染有关。

ClinicopathologicalFeaturesofHumanPapilomaVirusAsociatedSquamousCelCarcinomasoftheVulva

Objective:Toinvestigatetherelationshipbetweenhumanpapilomavirus(HPV)statusandclinicopathologicalfeaturesofvulvacarcinomaanditsclinicalsignificance.Methods:His-tologicalsectionsof37casesofvulvalcarcinomaweresubclassified.StandardPCR(HPVtypes6/11,16,18)wereappliedtoformalinfixed,parafinwaxsections.Results:Therewere24casesofkeratinizingsquamouscelcarcinoma(KSC),7casesofbasaloidcarcinoma(BC)and6casesofwartycarcinoma(WC).HPVs,MainlyHPV16,weredetectedin10ofthe37cases,andalofthemwerewomenwithBCandWCtypes.AlthoughBCandWCconstituted35%ofthetotalnumberofcases,theHPVdetectiveratewassignificantlyhigherthanthatofKSC(83.3%vs0.0%),andthetumorswerefrequentlyaccompaniedbyvalvarintra-epithelialneoplasm(VIN).Clinicaly,womenwithBCandWCwereyoungerthanwomenwithKSC(meanageatdiagnosisforWC,BCandKSCwere36.7,58.9,63.3yearsrespectively).Besides,theincidenceoflymphnodemetastasisinBCandWCwerelowerthanthatinKSC(7.6%vs25.0%).BCandWCweremorelikelytohavean-otherinvasiveornoninvasivesquamousneoplasmofthecervixandvagina(3/13vs0/24),andrecur-renceratewashigher(12.5%vs7.7%).However,theirsurvivalratesfolowingsurgicaltreatmentofrecurenceswerealsohigher.Squamouscelcarcinomaofthevulvaareetiologicalydiversetumorswhichhavediferentclinicalandpathologicalprofiles.Conclusion:Itissuggestedthatanetiologicalclassificationofsquamouscarcinomaofthevulvamayatleastbegroupedatpresentintoasmalbutsubstantialproportion(BCandWC)relatedtoHPVandthemajorityportion(KSC)ofunknowneti-ology.