| Autor: |
Rakislova N; Department of Pathology, Barcelona Institute of Global Health (ISGlobal), Hospital Clínic-University of Barcelona., Alemany L; Public Research Consortium of Epidemiology and Public Health (CIBER).; Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL., Clavero O; Public Research Consortium of Epidemiology and Public Health (CIBER).; Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL., Del Pino M; Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine, University of Barcelona., Saco A; Department of Pathology, Barcelona Institute of Global Health (ISGlobal), Hospital Clínic-University of Barcelona., Marimon L; Department of Pathology, Barcelona Institute of Global Health (ISGlobal), Hospital Clínic-University of Barcelona., Quirós B; Public Research Consortium of Epidemiology and Public Health (CIBER).; Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL., Lloveras B; Department of Pathology, Hospital Mar, Barcelona., Ribera-Cortada I; Department of Pathology, Barcelona Institute of Global Health (ISGlobal), Hospital Clínic-University of Barcelona., Alejo M; Department of Pathology, General Hospital of Hospitalet, L'Hospitalet de Llobregat, Spain., Pawlita M; Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany., Quint W; DDL Diagnostic Laboratory, Rijswijk, The Netherlands., de Sanjose S; Public Research Consortium of Epidemiology and Public Health (CIBER).; Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL., Ordi J; Department of Pathology, Barcelona Institute of Global Health (ISGlobal), Hospital Clínic-University of Barcelona.; Public Research Consortium of Epidemiology and Public Health (CIBER). |
| Abstrakt: |
Two etiopathogenic types of vulvar squamous cell carcinoma (VSCC) have been described: human papillomavirus (HPV)-associated and HPV-independent. Precursor lesions, frequently identified in the adjacent skin, are also distinct in the 2 types of VSCC: high-grade squamous intraepithelial lesions (HSILs) in HPV-associated VSCC and differentiated vulvar intraepithelial neoplasia (dVIN) or vulvar acanthosis with altered differentiation in HPV-independent VSCC. Although HPV-independent precursors mimicking HSIL have been described in the vulva, their frequency and morphologic spectrum have not been completely characterized. We explored, in a large series of HPV-independent VSSC, the frequency and the histologic features of precursors mimicking HSIL. We included 779 DNA HPV-negative/p16-negative VSCC with at least 1 cm of adjacent skin. We evaluated the histologic and immunohistochemical (p16 and p53) characteristics of the intraepithelial lesions, focusing on precursors mimicking HPV-associated vulvar HSIL. A total of 254 tumors (33%) had adjacent premalignant lesions. Of them, 186 (73%) had dVIN, 22 (9%) had vulvar acanthosis with altered differentiation, and 46 (18%) had lesions that mimicked HSIL. The mean age of the patients with these HSIL-like lesions was 72±15 years. Twenty-six of these HSIL-like lesions had basaloid morphology, 13 warty, and 7 mixed basaloid/warty features. All the HSIL-like precursors were DNA HPV-negative/p16-negative; 74% of them showed p53 abnormal staining and 35% of them had areas of conventional dVIN. In conclusion, about one fifth of the HPV-independent precursors mimic HSIL, showing either basaloid or warty features. Older age and the presence of areas of typical HPV-independent intraepithelial lesions, together with p16 negativity, should raise suspicion of an HPV-independent etiology. |
