分化型外阴上皮内肿瘤5例临床病理分析

Differentiated-type vulval intraepithelial neoplasia: a clinicopathologic analysis of five cases

目的探讨分化型外阴上皮内肿瘤形成(d VIN)的临床病理特征、鉴别诊断及其预后。方法对5例d VIN进行临床资料分析,组织形态学观察及免疫组化检测,并结合文献复习。结果 5例d VIN均发生于>55岁女性,平均年龄66.8岁,基底层细胞具非典型增生,核增大深染,核仁明显,可见异常核分裂象,胞质嗜酸性,表皮脚延伸,可见角化不全和单个细胞的角化过度,病变大部分存在硬化性苔藓的背景。免疫组化染色p53(+),p16(-),Ki-67仅局限于基底层细胞,HPV(-)。结论 d VIN是一种形态学难以识别的、与HPV感染无关的外阴鳞状细胞癌的癌前病变,明确组织病理学诊断对于及时治疗和预防外阴鳞状细胞癌具有重要意义。

Objective To explore the clinical pathological characteristics, differential diagnosis and prognosis of differentiated-type vulval intraepithelial neoplasia （dVIN）. Methods Five cases of dVIN was analyzed grossly, light microscopically and immunohistochemically and related literatures were reviewed. Results In dVIN, patients aged over 55 years, with mean of 66. 8 years. Basal cell atypia with nuclear hyperchromasia, karyomegaly, prominent nucleoli and atypical mitosis were noted in the basal layer. The epidermis was covered by hyperorthokeratosis and hyperpurakeratosis. The rete ridges were markedly elontated. The lesion most commonly presented with lichen sclerosis. In dVIN, p53 was positive, p16 was negative, and Ki-67 immunohistochemical expression was confined to the basal layer only. Conclusions dVIN is a precursor of invasive squamous cell carcinoma of the vulva and is not causally associated with HPV infection. Highly differentiated morphology make it a potential diagnostic pitfall. Definitive pathological diagnosis of dVIN plays an important role in its timely treatment and the prevention of vulvar carcinoma.