普通型外阴上皮内瘤变19例临床病理学研究

Clinicopathologic analysis of 19 cases of usual type vulvar intraepithelial neoplasia

目的探讨按照国际外阴疾病学会（ISSVD）2004年新分类标准对原外阴上皮内瘤变（VIN）Ⅱ级及以上级别以及鲍温病、鲍温样丘疹病的病理切片进行重新判读的结果及其手术治疗效果。方法调阅北京协和医院1999年至2006年入院手术的全部VINⅡ及以上级别患者、鲍温病及鲍温样丘疹病患者共19例的手术病理切片，请病理医师根据ISSVD2004新分类标准重新阅片分类，并总结其临床随访结果。结果根据ISSVD2004分类标准，所有19例患者的病理诊断均符合普通型VIN。进一步区分亚型，惟一1例鲍温病患者的两处病灶中，1处符合疣型VIN，另1处符合基底细胞型VIN，其余患者的病灶均符合疣型VIN。患者初次手术切除的治愈率为89％（17／19）；术后随访中有2例出现复发，但再次手术治疗效果好，复发病灶的病理均符合疣型VIN。结论原VINⅡ及以上级别病变以及鲍温病、鲍温样丘疹病按ISSVD2004分类标准以普通型VIN（疣型）为主，新的分类标准使VIN的病理诊断明显简化。手术切除治疗普通型VIN效果满意，但术后密切随访十分必要。

Objective To reclassify the patients with former diagnosis of vulvar intraepithelial neoplasia （VIN） Ⅱ , VINⅡ - Ⅲ, VINⅢ, Bowen disease and Bowenoid papulosis according to the 2004 modified terminology of International Society for the Study of Vulvar Disease （ISSVD） and evaluate the effects of surgical treatment. Methods According to the 2004 modified terminology of ISSVD, a retrospective review of the histological slides of 19 cases, who diagnosed as VIN H , VIN Ⅱ -Ⅲ, VIN Ⅲ, Bowen disease and Bowenoid papulosis treated in Peking Union Medical College Hospital from 1999 to 2006, were performed to reclassify by pathologist and the clinicopathologic data were also analyzed. Results According to the 2004 modified terminology of ISSVD, all 19 cases were reclassified as usual type VIN and were belonged to the subtype of warty type except one, the only Bowen disease patient whose one of focuses belonged to the subtype of basaloid type and the other focus belonged to the subtype of warty type. The primary cure rate of extended local excision was 89% （17/19）. There were two cases recurred during followup period, and were cured by second surgical treatment and the focuses of recurrence site were still diagnosed as warty type VIN. Conclusions The patients with former diagnosis of VIN Ⅱ, VIN Ⅱ -Ⅲ, VINⅢ, Bowen disease and Bowenoid papulosis are basically reclassified as usual type VIN （warty type ） according to the ：2004 modified terminology of ISSVD. The results showed that the diagnosis of VIN could be simplified by new terminology. The surgical excision is the good choice and combined cytologic and human papillomavirus （HPV） test during follow up is also important for patients of VIN.