结膜日光性角化病的临床病理学特点及其与HPV的关系

The clinicopathological features and HPV detection of conjunctival actinic keratosis

目的分析结膜日光性角化病(AK)的临床病理学特点及肿物组织中人乳头瘤病毒(HPV)的感染情况.方法回顾性系列病例研究.收集天津市眼科医院2005至2018年收治的18例(18只眼)结膜AK的临床及病理学资料,重新复习所有患者的组织切片,分析其临床病理学特点;并应用HPV通用引物行PCR检测石蜡标本中HPV感染情况.结果18例患者中男性15例,女性3例;发病年龄43~79岁,平均60岁;发生于鼻侧16例,颞侧2例;均发生于角结膜缘,肿物侵入角膜内1~4mm,平均侵入2mm;最大直径2.0~8.0mm,平均4.6mm.其中16例临床表现为白色或乳白色、轻度隆起的结节状肿物,边界清楚,周围伴有结膜充血;2例表现为棕黑色肿物,局部呈白色.组织病理学特征是结膜上皮增生和鳞状化生,表层细胞角化不全或角化过度,棘层增厚和基底细胞增生,结膜下常伴有日光性弹力纤维变性和淋巴细胞、浆细胞浸润;患者中15例为肥厚型,2例为色素型,1例为棘层松解型.18例患者肿物标本HPV检测均呈阴性.所有患者均行手术完整切除,术后随访1.0~10.4年,失访8例,回访到10例患者均未复发.结论结膜AK是好发于角结膜缘部位的上皮性癌前病变,HPV感染可能不是其致病因素.

Objective To describe the clinicopathological features of conjunctival actinic keratosis(AK)and relation to the infection of human papillomavirus(HPV).Method Retrospective case series study.Eighteen cases(18 eyes)of conjunctival AK were obtained in Tianjin Eye Hospital and Institute(2005-2018).The clinical and histopathological features were studied.HPV was detected by a modified general primer HPV polymerase chain reaction(PCR)system in all formalin-fixed,paraffin-embedded specimens.Results The male to female ratio was 5∶1.The mean age at diagnosis was 60 years(range:43-79 years).Sixteen cases were located in the nasal interpalpebral region,and two cases were located in the temporal interpalpebral region.All cases were located in corneal limbus,and the mean distance of corneal invasion was 2 mm(range,1-4 mm).The mean diameter was 4.6 mm(range,2.0-8.0 mm).Clinically,most lesions(16 cases)appeared as a white or milky,flat plaque with clear borderline and conjunctival hyperemia;a few lesions(2 cases)showed a brown-black mass,partially white.Pathologically,conjunctival AK was a proliferation of epithelium with prominent parakeratosis or hyperkeratosis,stratum spinosm thickening and basal cell proliferation.Many AKs show solar elastosis and a mild inflammatory infiltrate of lymphocytes and plasma cells in the stroma.Most lesions(15 cases)were hypertrophic type,two cases were pigmented type,and one case was acantholytic type.HPV was negative in 18 cases.All case were removed by complete surgical excision.The rage of follow-up period was 1.0-10.4 years,ten cases were recorded,and no case recurred after surgical excision.Conclusions Conjunctival AK is epithelial precancerous lesion that occurs in the keratoconjunctival margin.HPV infection might not be a causative factor in conjunctival AK.