6例分化型外阴上皮内瘤变临床病理观察

发布时间：2018-08-11 08:29

【摘要】：目的探讨分化型外阴上皮内瘤变(differentiated-type vulvar intraepithelial neoplasia,dVIN)的临床病理学特征、鉴别诊断、治疗及预后。方法回顾性分析6例dVIN的临床特点、病理形态学和免疫表型特征,并复习相关文献。结果患者均为女性,年龄53~80岁,平均62岁,临床特点大多表现为外阴白斑、激惹、瘙痒、疼痛、溃疡、触血。病理组织学特征表现:基底与副基底层显著增生,上皮角下延、吻合,细胞显著异型,核仁明显,核分裂活跃,伴异常角化;中、表层细胞高度分化,细胞间桥显著,伴明显的胞质嗜酸性改变,表层角化过度与角化不全;邻近上皮真皮水肿与胶原化,带状淋巴细胞浸润,表皮增生与角化过度。免疫表型:p53在dVIN中的阳性率为83.3%(5/6),p16不表达(0/6),dVIN基底层和副基底层细胞Ki-67增殖指数90%。4例随访时间为6~36个月,平均17个月,其中1例术后9个月死亡,1例术后6个月复发,复发和死亡的2例同时或异时伴浸润性鳞状细胞癌,其余2例术后分别随访18个月和36个月,均无复发。结论 dVIN是一种少见的高级别外阴上皮内病变,具有高的、潜在进展危险性,p53、p16及Ki-67联合使用有助于dVIN的诊断。
[Abstract]:Objective to investigate the clinicopathological features, differential diagnosis, treatment and prognosis of differentiated-type vulvar intraepithelial neoplasia. Methods the clinical, histopathological and immunophenotypic features of 6 cases of dVIN were analyzed retrospectively. Results all the patients were female, aged 5380 years (mean 62 years). Most of the clinical features were vulvar leukoplakia, irritation, pruritus, pain, ulcer and blood contact. Histopathological features: the basal and accessory basal layers proliferated significantly, the epithelial horn extended, anastomosed, the cells were significantly abnormal, nucleolus was obvious, mitosis was active, accompanied with abnormal keratosis, the surface cells were highly differentiated, and the intercellular bridges were significant. Accompanied by obvious cytoplasmic eosinophilic changes, hyperkeratosis and hypokeratosis in the surface layer, edema and collagenization of the adjacent epithelial dermis, infiltration of banded lymphocytes, hyperkeratosis and hyperkeratosis of the epidermis. The positive rate of immunophenotype: p53 in dVIN was 83.3% (5 / 6) and p16 was not expressed (0 / 6). The proliferative index (Ki-67) of the basal and accessory basal layers of dVIN was followed up for 6 ~ 36 months with an average of 17 months. One case died 9 months after operation and 1 case recurred 6 months after operation. The recurrence and death of 2 cases with invasive squamous cell carcinoma at the same time or at the same time, the other two cases were followed up for 18 months and 36 months, respectively, no recurrence. Conclusion dVIN is a rare high-grade intraepithelial lesion of vulva. It has high potential risk of progression and combined use of p53p16 and Ki-67 is helpful for the diagnosis of dVIN.
【作者单位】：安徽医科大学妇幼保健临床学院/安徽省妇幼保健院病理科;安徽医科大学妇幼保健临床学院/安徽省妇幼保健院妇产科;
【分类号】：R737.33

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