PCR检测与光镜、电镜观察相结合诊断女阴尖锐湿疣

DIAGNOSIS OF VULVAL CONDYLOMA ACUMINATUM BYCOMBINATION OF PCR EXAMINATION WITHLIGHT AND ELECTRON MICROSCOPIC OBSERVATION

将聚合酶链式反应（ＰＣＲ）技术与光镜、电镜下的形态学观察相结合，对６３例女性生殖道疣样病损活检标本进行综合研究。ＰＣＲ检测结果：在２６例新鲜组织中，人乳头状瘤病毒（ＨＰＶ）６／１１ｂ型阳性者２１例（８０．８％）；在１２例石蜡包埋组织中，ＨＰＶ６／１１ｂ阳性者７例（５８．３％），总阳性率为７３．７％。光镜观察：２１例ＨＰＶ阳性病例中，１９例显示典型的尖锐湿疣病变，另２例未发现典型的挖空细胞，基底细胞增生也不明显；ＨＰＶ阴性病例绝大部分无典型尖锐湿疣表现，但有１例在中、表层也出现了成堆的挖空细胞。电镜观察发现：ＨＰＶ阳性病例的超微结构显示一定程度的规律性。提示：尖锐湿疣系ＨＰＶ感染所引起，将光镜、电镜的形态学观察与ＰＣＲ技术检测ＨＰＶ相结合，对之进行综合诊断，可减少尖锐湿疣的误诊与漏诊；ＨＰＶ阳性的湿疣组织中，病毒颗粒的出现机率极小，研究中发现的与病毒感染有关的超微病变。

HPVDNA and corresponding ultrastructural changes were studied with polymerase chain reaction(PCR) and electron microscopy (EM) in 63 female genital condylomatoid biopsy specimens.The PCR examinational results revealed that Type 6/11b HPVDNA was detected in 21 of the 26 fresh specimens (80.8%) and in 7 of 12 paraffinembedded tissue specimens (58.3%),the total HPVDNA positivity rate being 73.7%.Under light microscope,19 of 21 HPVDNA positive cases showed typical pathological changes of condyloma acuminatum (CA),while in the other 2 cases no such changes could be found.No typical CA appearance was found in the HPVDNA negative cases except one case which showed a large number of koilocytes in the stratum spinosum that near the surface.Ultrastructure of HPVDNA positive cases under EM displayed some characteristic changes,which were likely related to virus infection.It could be of great value in decreasing misdiagnosis of CA to combine PCR examination with light and electron microscopic observation in the diagnosis of genital condyloma latum.Virus particles were seldom found in the CA specimens.The characteristic changes of HPV positive CA might be used in the diagnosis of CA under EM.