摘要
Background:Differentiated vulvar intraepithelial neoplasia(dVIN)is a non-human papilloma virus(HPV)-related high-grade precursor lesion to vulvar squamous cell carcinoma(vSCCa).Although TP53 gene mutations have been identified in 80%of dVIN,its role in dVIN pathogenesis as well as malignant transformation is still being poorly understood.Poor reproducible diagnostic criteria and ambiguous p53 immunostaining patterns,along with morphologic discordance still pose a diagnostic challenge.Methods:A series of 60 cases of dVIN-related vSCCa along with adjacent dVIN were evaluated.Clinicopathological features as well as immunohistochemical results were recorded on the resection-confirmed dVIN-related vSCCa.Results:The average age of the patients was 71 years.Thirty-five cases(58.4%)of dVIN-related vSCCa were moderately differentiated,fourteen cases(23.3%)were poorly differentiated,and the remaining eleven cases(18.3%)were well-differentiated.Twenty-nine cases(48.3%)were found to have lichen sclerosus adjacent to dVIN.In terms of p53 and p16 expression in dVIN-related vSCCa and the adjacent dVIN,fifty-five(91.7%)dVIN showed mutant p53 immunostaining pattern with strong positive expression in 80%cases(basal/para-basal expression)and null pattern expression in 11.7%cases.Five(8.3%)dVIN showed p53 wild-type staining pattern.The wild-type pattern were seen in 5%of vSCCa and p53 null pattern were seen in 13.3%vSCCa.Six cases demonstrated atypical staining patterns:two cases showed p53 null expression in dVIN but p53 overexpression in invasive carcinoma;three cases exhibited p53 null expression in invasive carcinoma,with the adjacent dVIN showing basal and para-basal mutant(2 cases)and wild-type(1 case)p53 expression patterns.A single case demonstrated p53 wild-type pattern in dVIN and overexpression in invasive carcinoma.In addition,65%dVIN were p16 negative and 31.7%dVIN had patchy p16 staining.Conclusion:Clinical and prognostic value of the ambiguous/inconsistent patterns are uncertain and molecular studies are needed for further characterization.
