J Korean Med Sci.  2001 Dec;16(6):762-768. 10.3346/jkms.2001.16.6.762.

Papillary Immature Metaplasia of the Uterine Cervix: a Report of 5 Cases with an Emphasis on the Differential Diagnosis from Reactive Squamous Metaplasia, High-Grade Squamous Intraepithelial Lesion and Papillary Squamous Cell Carcinoma

• Kang GH
• Min K
• Shim YH
• Kim KR

• KMID: 648359
• DOI: http://doi.org/10.3346/jkms.2001.16.6.762

Abstract

Papillary immature metaplasia (PIM) is a distinctive exophytic lesion of the uterine cervix and shares some histologic and cytologic features with ordinary squamous metaplasia (SM), atypical immature squamous metaplasia (AIM), high-grade squamous intraepithelial neoplasia (HSIL) and papillary squamous cell carcinoma (PSC). PIM has been suggested to be a subset of condyloma associated with low-risk type human papilloma virus (HPV), however, the etiologic role of HPV and biologic behavior of the disease are still elusive. We compared the clinical and histopathological findings, immunohistochemical expression of Ki-67 and p53 protein, and HPV typing of 5 cases of PIM with SM (n=9), HSIL (n=6), and PSC (n=4) to know the helpful features for the differential diagnosis. Histologically, all 5 cases showed a papillary proliferation of immature metaplastic cells involving the proximal transformation zone and endocervix. On HPV typing by polymerase chain reaction-restriction fragment length polymorphism, 2 out of 5 PIM were confirmed to have HPV 6 or HPV 11, while 2 out of 4 PSC were proved having HPV 31 and HPV 16 each. Ki-67 labeling index and mitotic index of PIM were significantly lower than those of HSIL or PSC. There were no significant differences of Ki-67 labeling index and mitotic index between PIM and SM. The expression of p53 varied among the groups and thus it was not helpful for the differential diagnosis.

Keyword

Metaplasia; Cervix Neoplasms; Carcinoma, Papillary; Papillomavirus; Ki-67 Antigen; Protein p53

MeSH Terms

Adult
Carcinoma in Situ/*pathology
Carcinoma, Papillary/*pathology
Carcinoma, Squamous Cell/*pathology
Cervix Neoplasms/*pathology
DNA, Viral/analysis
Diagnosis, Differential
Epithelial Cells/chemistry/pathology
Female
Follow-Up Studies
Human
Ki-67 Antigen/analysis
Papillomavirus/genetics
Papillomavirus Infections/pathology
Protein p53/analysis
Tumor Virus Infections/pathology
Vaginal Smears