CAJ | 학술논문

目的探讨外阴上皮内肿瘤形成(VIN)的临床、病理和免疫组织化学特征.方法按国际外阴阴道疾病研究学会( ISSVD) 2004年的分类标准,从2009年2月至2011年12月间在北京五洲女子医院行外阴活检的女性患者中选取VIN患者,分为普通性VIN (u-VIN)和分化性VIN( d-VIN)两组进行研究,并进行Ki-67、p16和p53免疫组织化学MaxVision法染色.结果 237例中有20例VlN,占同期所有外阴活检病例的8.4％ (20/237).u-VIN患者17例,平均年龄29.6岁,表现为全层或接近全层出现不典型细胞,类似于宫颈高级别鳞状上皮内肿瘤形成.Ki-67和p16免疫组织化学染色呈弥漫强阳性,高危型HPV阳性.d-VIN比u-VIN少见,本组仅3例,均发生于50岁以上女性,平均年龄53.7岁,多有硬化性苔藓背景,病变上皮增厚、上皮脚延长和角化不全,不典型性局限于鳞状上皮的基底和副基底部,病变细胞增大,具有丰富的嗜酸性胞质,核仁突出,伴有细胞成分增加或轻度核深染,形成发育不全的角化珠.d-VIN的p53免疫组织化学染色呈强阳性,Ki-67和少数p16反应仅局限于基底层少数细胞.结论 VIN是外阴鳞状细胞癌的癌前病变,新的ISSVD分类将VIN均归为高级别病变,明确的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.
목적 탐토외음상피내종류형성(VIN)적림상、병리화면역조직화학특정.방법 안국제외음음도질병연구학회( ISSVD) 2004년적분류표준,종2009년2월지2011년12월간재북경오주녀자의원행외음활검적녀성환자중선취VIN환자,분위보통성VIN (u-VIN)화분화성VIN( d-VIN)량조진행연구,병진행Ki-67、p16화p53면역조직화학MaxVision법염색.결과 237례중유20례VlN,점동기소유외음활검병례적8.4％ (20/237).u-VIN환자17례,평균년령29.6세,표현위전층혹접근전층출현불전형세포,유사우궁경고급별린상상피내종류형성.Ki-67화p16면역조직화학염색정미만강양성,고위형HPV양성.d-VIN비u-VIN소견,본조부3례,균발생우50세이상녀성,평균년령53.7세,다유경화성태선배경,병변상피증후、상피각연장화각화불전,불전형성국한우린상상피적기저화부기저부,병변세포증대,구유봉부적기산성포질,핵인돌출,반유세포성분증가혹경도핵심염,형성발육불전적각화주.d-VIN적p53면역조직화학염색정강양성,Ki-67화소수p16반응부국한우기저층소수세포.결론 VIN시외음린상세포암적암전병변,신적ISSVD분류장VIN균귀위고급별병변,명학적조직병이학진단대우급시치료화예방외음린상세포암구유중요의의.
Objective To investigate the clinical,pathological and immunohistochemical features of vulvar intraepithelial neoplasia (VIN).Methods According to the 2004 modified terminology of International Society for the Study of Vulvovaginal Diseases (ISSVD),the cases were diagnosed as VIN from patients who had performed vulvar biopsy in Beijing Wuzhou Women's Hospital from February 2009 to December 2011,which were reclassified as usual VIN and differentiated VIN.The clinical and pathological studies were conducted respectively.MaxVision immunohistochemical staining was used to detect the expression of Ki-67,pl6 and p53 proteins.Results There were 20 cases of VIN in 237 patients,and the incidence of VIN was 8.4％ in all of contemporary vulvar biopsy.In 17 cases of usual VIN,mean age was 29.6 years,the lesion typically presented with atypical cells involving almost all layers of the epithelium,which was equivalent to the higl-grade squamous intraepithelial neoplasia of cervix.Immtmohistochemistry for Ki-67 and p16 was strongly positive in usual VIN.High risk human papillomavirus (HPV) detection was also positive.The incidence of differentiated VIN was less than usual VIN,and there were only 3 cases in this study.In differentiated VIN,patients aged over 50 years,with mean of 53.7 years,and the lesion most commonly presented with lichen sclerosis background.There were epithelial thickening and extending,and parakeratosis,and atypia was strictly confined to the basal and parabasal layers of the epithelium where the cells enlarged with abundant eosinophilic cytoplasm,presented with prominent nucleoli,increased cellularity and abnormal keratinization.In differentiated VIN,p53 was strongly positive,Ki-67 and p16 immunohistochemical expression was confined to the basal layer only.Conclusions VIN is a precursor of invasive squamous cell carcinoma of the vulva.The modified terminology of ISSVD classifies VIN as highgrade lesions.Definitive pathological diagnosis of VIN plays an important role in its timely treatment and the prevention of vulvar carcinoma.