外耳道乳头状瘤组织形态学观察及HPV分型的分析

Observation of Morphology and Analysis of HPV Typing in Papilloma of the External Auditory Canal Tissues

目的:观察41例外耳道乳头状瘤(PEAC)患者的46个病变组织病理形态学变化,探讨人乳头瘤病毒(HPV)型别分布及临床意义。方法:收集2019年1月—2021年10月安徽省当涂县人民医院病理科诊断为外耳道乳头状瘤的41例患者的46个病变组织蜡块,先行显微镜下的病变组织形态学观察,再从其石蜡组织中提取HPV DNA,采用聚合酶链式反应(PCR)和基因芯片技术对患者的瘤组织行23种高危和低危型HPV检测。结果:对41例外耳道乳头状瘤的46个病变,镜下观察,鳞状上皮均呈乳头状增生,轻度到高度角化,可见散在不全角化的细胞,中心结缔组织内伴有淋巴细胞浸润,鳞状上皮的表层和中层内可见数目不等的挖空细胞,有少量核分裂,20例鳞状上皮下1/3可见异型增生的细胞层。41例外耳道乳头状瘤患者HPV总检出率为75.61%,单一型别检出率和多型别检出率分别为73.17%和2.44%,单一型别均为6型,多型别为6+16型。结论:外耳道乳头状瘤是由于外耳道皮肤炎症或受损后感染HPV所致的一种耳鼻喉科的疾病,以低危单一6型HPV感染为主,伴有少量的多型HPV感染。行该病变的病理观察和HPV分型检测,有助于本病的病因学诊断,对防止其病变的传播、复发及恶变都具有重要的临床指导意义。

Objective:Pathological changes of 46 diseased tissues from papilloma of the external auditory canal(PEAC)in 41 patients were observed,to investigate the distribution and clinical significance of human papilloma virus(HPV)types.Methods:A total of 46 wax blocks were collected from 41 patients diagnosed as PEAC in January 2019 to October 2021.The pathological morphology changes were first observed under the microscope,and HPV DNA was extracted from the paraffin tissues,polymerase chain reaction(PCR)and gene chip technology were used to detect 23 high-risk and low-risk HPV types in tumor tissues.Results:Microscopic observation of 46 lesions in 41 cases of PEAC showed papillary hyperplasia,squamous epithelium with mild to high keratinization,scattered incomplete keratinized cells,lymphocyte infiltration in central connective tissues,varying numbers of hollowed cells in the surface and middle layer of squamous epithelium and a small amount of nuclear division.Heterotype hyperplastic cell layers were seen in the 1/3 place beneath squamous epithelium in 20 cases.The total detection rate of HPV in 41 PEAC patients was 75.61%,the detection rate of single type and the multi-type was 73.17%and 2.44%,respectively.All the single type was 6 type,and the multi-type was 6+16 type.Conclusion:PEAC is an otorhinolaryngology disease caused by HPV infection after skin inflammation or damage of the external auditory canal.It is dominated by low-risk single type infection of HPV 6 type,accompanied by a small number of multi-type HPV infection.The pathological observation and HPV typing testing of PEAC are helpful to the etiological diagnosis of PEAC,and have important clinical guiding significance to prevent the spread,recurrence and malignant transformation of PEAC.