Cm. Mclachlin et al., DISPARITIES IN MEAN AGE AND HISTOPATHOLOGIC GRADE BETWEEN HUMAN-PAPILLOMAVIRUS TYPE-SPECIFIC EARLY CERVICAL NEOPLASMS, Human pathology, 28(11), 1997, pp. 1226-1229
Noninvasive squamous and glandular precursor lesions associated with h
uman papillomavirus (HPV) types 16 and 18 have been reported to vary i
n morphology. HPV 16 is associated predominantly with high-grade squam
ous intraepithelial lesions (HSIL; cervical intraepithelial neoplasia
(GIN 2 and 3), and HPV 18 is associated with low-grade squamous intrae
pithelial lesions (condyloma/CIN 1) and CIN 3/adenocarcinoma in situ (
ACIS). This study explored the relationship of morphologic growth patt
ern in these precursor groups with age of presentation. One hundred fo
urteen CIN lesions (including those with ACIS), associated with HPV 16
or 18, were subdivided into well-differentiated low-and high-grade SI
L, (CIN 1 and 2, respectively), poorly differentiated HSIL (GIN 3) wit
h or without ACIS. I-IPV was detected by polymerase chain reaction (PC
R) amplification with L1 consensus or type-specific E7 primers and typ
ed by restriction fragment length polymorphism (RFLP) analysis. Age of
the patient was obtained from the pathology report Mean age for each
group was as follows: Low-risk HPVs, 25 years; HPV 18 CEN 1-2, 21.6 yr
s; HPV 18 CIN 3/ACIS, 35.2 yrs; HPV 16 CIN 1,2, 25.9 ys; and HPV 16 CI
N 3, 29.8 ys. There were significant differences in mean ages between
HPV 18 CIN 1 and 2 and HPV 16 CIN 1 to 2 (P =.04), HPV 16 CIN 1-2 and
CIN 3 (P =.01) and HPV 18 CIN 1 to 2 and HPV 18 CIN 3/ACIS (P =.00001)
. None of the cases of HPV 18-associated CIN3/ACIS was associated with
a CINI lesion. The disparity in mean ages between well and poorly dif
ferentiated HPV 16/18 related that precursor lesions could reflect fac
tors such as morphologic progression with increasing age, different ra
tes of lesion persistence, depending on grade, or efficiency of detect
ion between the two groups. The marked difference in mean age between
HPV 18-associated CIN 1-2 and CIN 3/ACIS, combined with their lack of
coexistence in the same cervix, raises alternate possibilities that sp
ecific viral or host factors may determine the morphological phenotype
associated with some HPV 18 infections. In the latter, the possibilit
y that age independently confers an increased risk for higher-grade le
sions should be considered. Copyright (C) 1997 by W.B. Saunders Compan
y.