挖空细胞的本质及尖锐湿疣病理诊断

目的 从分子生物学角度，寻找尖锐湿疣比较确切可行的病理诊断标准。方法 采用HE、HPV-CAg免疫组化、HPV-DNA原位杂交组化染色和超薄切片等方法检测50例尖锐湿疣；用原位末端标记TUNEL染色，对20例尖锐湿疣进行观察。结果 鳞状上皮呈尖细的乳头状增生，角化不全和乳头纤维轴索中毛细血管丛状增生，棘层中上部和颗粒层有多少不等的挖空细胞，单个散在、成群或广泛分布，胞质空亮，核皱缩成星形或毛虫样，无炎细胞反应。原位杂交组化HPV-DNA的阳性细胞比免疫组化HPV-CAg阳性细胞明显增多。原位末端标记TUNEL染色及光镜、电镜观察，显示所有的挖空细胞均呈现细胞凋亡变化。结论 尖锐湿疣挖空细胞是由HPV所引起的凋亡细胞。从形态学上确认其凋亡特征即可确定尖锐湿疣的诊断，角化不全和乳头间质血管丛状增生可作佐证。难以确认挖空细胞的疑难病例，可采用原位杂交组化技术。

Consulting the nature of koilocytes and the criterion of pathologic diagnosis of condyloma acuminatum

Purpose To search the criterion of pathologic diagnosis of condyloma acuminatum at an angle of molecular biology. Methods Fifty cases of condyloma acuminatum were detected with HE, HPV CAg, immunohistochemisty, HPV DNA in situ hybrihistochemical staining and ultrasection; 20 cases were observed with in situ end labelling TUNEL staining. Results Epithelium revealed fine papilla growth, parakeratosis and plexus proliferation of small blood vessel in papilla stroma. There are more or less koilocytes on middle and upper parts of spinal stratum, arranged single separately, in group or diffusely, cytoplasm were clear, nuclei were pyknotic to form starlike or caterpillarlike, no inflammatory cell reacted surrounding it. ISH HPV DNA positive cells were much more than IHC HPV CAg positive cells. With in situ and labelling TUNEL staining and observed under microscopy, electron microscope, all Koilocytic nuclei showed apoptotic change. Conclusions Koilocytes of condyloma acuminatum are apoptotic cells induced by HPV. Making pathologic diagnosis of condyloma acuminatum when the apoptotic feature of koilocytes is confirmed morphologically. Parakeratosis and plexus proliferation of small blood vesel in papilla stoma may be as a supplementary proof.In situ hybrihistochemical technique may be used in the case which is difficult to confirm the koilocytic nature.