Sabato 27 ottobre 2012 - Pacini Editore

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7 Mourtzinos N, Puri PK, Wang G, et al. CD4/CD8 double negative pagetoid
reticulosis: a case report and literature review. J Cutan Pathol
2010;37:491-6.
HPV-DnA load in squamous cervical intraepithelial
lesions (SIL): correlation with histologic
and viral findings
B. Dal Bello1 , A. Spinillo2 , B. Gardella2 , P. Alberizzi1 , M. Roccio2
, S. Cesari1 , E.M. Silini3 1 Fondazione IRCCS Policlinico San Matteo, Università di Pavia, SC
Anatomia Patologica, Pavia, Italy; 2 Fondazione IRCCS Policlinico San
Matteo- Università di Pavia, SC Ostetricia e Ginecologia, Pavia, Italy;
3 Azienda Ospedaliero-Universitaria di Parma, SC Anatomia Patologica,
Parma, Italy
Background. The role of HPV load in the development and progression
of SIL is unclear and its relationship with other virological
features is controversial 1 2 . We aimed to define the correlation
of HPV titres with relevant clinical and virological findings in
women undergoing colposcopy for abnormal cervical cytology.
Materials and methods. We evaluated cervical scrapings,
collected in ThinPrep-Preserv-Cyt solution from 501 women
(mean age 37 yrs) undergoing colposcopy for abnormal cytology.
Full HPV genotyping by INNOLiPA SPF-10 (EXTRA test,
Innogenetics) was available in all sample 3 . During colposcopy,
397 (79%) women had targeted cervical biopsy. DNA extraction
from cervical scrapings was performed using an automatic
instrument (Magtration system 12GC, VODEN). HPV DNA
quantification was obtained by real time PCR (RotorGene,
Explera) using SPF10 primers. beta-globin gene was quantified
to normalize HPV loads. Stepwise logistic regression analysis
Tab. I. Correlation of HpV load with histologic, virologic and clinical features.
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
was performed to evaluate the association between viral load
and viral genotypes adjusting for number of infecting type and
lesion severity. Multinomial logistic regression was performed
to correlate viral load with histological and virological findings.
Results. Overall, LSIL was diagnosed in 42.5% and HSIL/
carcinoma in 32% of women. HPV genotyping identified 27 different
viral types. Multiple infections were present in 217 (43%)
scrapings. In 68 (13.5%) samples no specific viral type was found
(untypable). Correlations of clinical, virological and histological
features with viral load are summarized in Table I.
HPV DNA titre and HPV/beta-globin ratio significantly increased
with severity of cytological (p 0.001) and histological lesions (p
0.011), multiple infection (p 0.000), number of HPV types (p
0.000), and class of oncogenic risk. More specifically, multiple
HR and HR-LR type infections had higher viral titres than single
HR and LR type infections (p 0.000), whereas untypable samples
had lower titres than other groups. Age and menopausal status
didn’t affect viral load.
Viral titres were positively correlated with infections by HPV
type 6 (p 0.006), 31 (p 0.025), 53 (p 0.003), 56 (p 0.016), 66 (p
0.010) and 82 (p 0.018); no correlation was found for HPV 16.
At stepwise regression analysis after correction for number of viral
types and lesion severity, normalized HPV titres were directly
correlated with infections by HPV 31, 44, 66 and 74 and inversely
correlated with HPV 18 and 35.
At multivariate analysis, viral titres significantly correlated with
the number of infecting types (p 0.000) and the presence of low
grade SIL (p 0.043).
Discussion. Available data regarding HVP load and its clinical
significance are still controversial and limited by sample size and
Variable Category n HPV titres HPV/b globin ratio p
Cyto/histo diagnosis
histologic diagnosis
Multiple infection
Number of viral types
class of oncogenic risk
age
Negative 140 10.25±8.4 1.42±1.67
lSil 225 10.6±5.1 1.51±0.91
hSil 129 11.03±6.0 1.55±0.77
Negative 102 9.76±5.0 1.32±0.80
lSil 169 10.58±5.3 1.48±0.92
hSil/carcinoma 126 10.97±6.1 1.63±0.65
No viral type 68 7.85±5.4 0.92±0.42
Single 216 9.58±5.1 1.26±0.57
Multiple 217 12.66±7.4 8.35±7.78
0 68 7.85±5.4 0.93±0.42
1 216 9.58±5.1 1.23±0.57
2 82 12.35±9.8 1.81±2.11
3 70 11.98±6.1 1,71±0.82
4 42 13.74±4.9 2.33±1.28
5 23 13.84±4.3 2.22±0.72
No viral type 68 7.85±5.4 0.93±0.42
lR single 48 9.94±4.1 1.29±0.63
hR-lR 110 13.41±8.8 2.08±1.86
hR single 160 9.40±5.3 1.24±0.56
hR multiple 106 11.82±5.5 1.77±1.05
Unclassified 8 11±5.8 1.39±0.57
< 21 9.93±4.5 1.38±0.93
22-30 11.3±6.1 26.3±2.54
31-40 (reference) 154 9.80±5.1 1.50±0.94
41-50 11.2±8.6 1.50±0.75
> 50 10.6±5.4 1.58±1.72
0.001
0.011
0.000
0.000
0.000
0.789