外阴鳞状细胞癌及上皮内病变的临床特征分析

Clinical characteristics of vulvar squamous cell carcinoma and its intraepithelial lesions

目的分析外阴鳞状细胞癌(VSCC)及外阴鳞状上皮内病变(VSIL)的临床特征。方法收集2015年9月—2021年6月于徐州市中心医院病理确诊为VSCC、外阴高级别鳞状上皮内病变(VHSIL)、外阴低级别鳞状上皮内病变(VLSIL)患者的临床病理资料。回顾性比较VSCC及VSIL患者的临床症状、病灶部位、阴道镜表现、人乳头瘤病毒(HPV)感染的阳性率及亚型,并分析VSCC患者的临床病理特征。结果VLSIL、VHSIL、VSCC患者平均年龄分别为(45.81±18.12)岁、(54.76±18.74)岁和(65.59±14.61)岁,差异有统计学意义(P<0.05)。VSCC、VHSIL及VLSIL组患者临床症状多表现为外阴瘙痒和疼痛。69.57%的VSIL病灶位于外阴后联合,68.18%的VSCC病灶位于大阴唇。阴道镜下醋白反应:VLSIL组100%,VHSIL组88.00%,VSCC组90.91%。血管征象:4.76%的VLSIL和20.00%的VHSIL有点状血管样结构,而77.27%的VSCC有点状或异型血管图像。HPV感染率:VLSIL组100%,VHSIL组76.00%,VSCC组40.90%,VHSIL、VSCC组HPV16阳性率高于VLSIL组(P<0.05)。与HPV阳性VSCC组相比,HPV阴性VSCC组患者年龄更大,肿瘤中低分化占比更高,FIGO分期Ⅲ—Ⅳ期占比更高,差异有统计学意义(P<0.05)。结论VSCC与VSIL患者常见外阴瘙痒、斑块、HPV16感染,阴道镜下以醋白征象为主,VSCC血管征象明显。需进行外阴区及阴道镜检查以提高早期诊断率。HPV阴性VSCC肿瘤分级更低,分期更晚,需重视基于HPV的VSCC风险分层管理。

Objective To analyze the clinical features of vulvar squamous cell carcinoma(VSCC)and vulvar subepithelial intraepithelial lesion(VSIL).Methods Clinicopathologic data were collected from patients who were pathologically diagnosed with VSCC,vulvar high-grade squamous intraepithelial lesion(VHSIL),and vulvar low-grade squamous intraepithelial lesion(VLSIL)in Xuzhou Central Hospital from September 2015 to June 2021.Then,the clinical symptoms,lesion sites,colposcopic manifestations,the positivity rate and subtypes of human papillomavirus(HPV)infection in VSCC and VSIL were retrospectively compared,in order to analyze the clinicopathological features of patients with VSCC.Results The average age of patients with VLSIL,VHSIL and VSCC were 45.81±18.12,54.76±18.74 and 65.59±14.61 years,respectively,with statistical differences(P<0.05).Patients in the VSCC,VHSIL and VLSIL groups mostly presented vulvar itching and pain,where 69.57% of VSIL lesions were located in the posterior vulvar union area and 68.18% of VSCC lesions were located in the labia majora.Colposcopic vinyl white reaction:100% in the VLSIL group,88.00% in the VHSIL group and 90.91%in the VSCC group.Vascular signs:4.76% of VLSIL and 20.00% of VHSIL had punctate vasculature-like structures,whereas 77.27% of VSCC had punctate or heterogeneous vascular images.HPV infection rate:100% in the VLSIL group,76.00% in the VHSIL group,and 40.90% in the VSCC group,and the VHSIL and VSCC groups presented higher HPV16 positive rates than the VLSIL group(P<0.05).Compared with the HPV-positive VSCC group,the HPV-negative VSCC group was older,and showed an increased percentage of poorly differentiated tumors,and an increased percentage of FIGO stage Ⅲ-Ⅳ,with statistical differences(P<0.05).Conclusions VSCC and VSIL patients commouly show vulvar itching,plaques,and HPV16 infection,with predominantly vinegar-white signs in colposcopy,and vascularized structures were obvious in VSCC.Vulvar area and colposcopy are needed to improve early diagnostic rate.HPV-negative VSCC has a lower tumor grade and later tumor stage,and HPV-based risk stratification of VSCC should be emphasized.