Ki-67 expression in anal intraepithelial neoplasia in AIDS

Abstract

CONTEXT: AIDS is one of the most important risk factors for progression and recurrence of anogenital condyloma. In a previous work, we observed that patients with warts and high-grade AIN (HAIN) had recurrences more frequently than did patients with warts without AIN. The mechanisms of this increased incidence of high-grade lesions in AIDS are not known. OBJECTIVE: We studied the expression of the proliferative marker Ki-67 by immunohistochemical methods, in specimens of anal condyloma from HIV+ patients to clarify whether its expression can be associated to the grade of AIN. DESIGN: A retrospective study of hiltological specimens. SETTING: University referral unit. SAMPLE: 34 patients were divided into two groups: (1) condylomas with low grade AIN (LAIN), with 25 patients; and (2) condylomas with HAIN, with 9 patients. In this latter group we examined two areas: 2A (HAIN area) and 2B (LAIN area). MAIN MEASUREMENTS: The immunohistochemical reaction for Ki-67 was done on histological sections. Slices were lightly stained with hematoxylin, to help us in Ki-67 positive cell counting. The percentage of Ki-67 marked nuclei was calculated. We applied one-way variance analysis for statistics. RESULTS: The mean number of Ki-67 positive cells in group 1 was 19.68 ± 10.99; in group 2 (area A) it was 46.73 ± 10.409; and in area B it was 36.43 ± 14.731. There were statistical differences between groups 1 and 2A and between groups 1 and 2B. Ki-67 positive cells predominated in the lower layer in LAIN. Positive Ki-67 cells were found in all layers in group 2A, and in group 2B they predominated in the two lower or in all layers of the epithelium. CONCLUSIONS: Our results suggest that LAIN areas (using routine staining techniques) in HAIN can have a biological behavior more similar to HAIN.

P16 and Ki67 Immunostaining is a Useful Adjunct in the Assessment of Biopsies for HPV-Associated Anal Intraepithelial Neoplasia

“…Although not specifically associated with HPV infection, Ki67 expression has been described as helpful in distinguishing low-grade from high-grade SIL in biopsies from the cervix and anal canal. 1,3,4,12,16 In studies of anal biopsies, Haber et al, 8 Mullerat et al, 16 and Calore et al 3 found that Ki67 expression increased as diagnoses advanced from condyloma through AIN I to AIN II/III. Ki67 positivity predominated in the lower layers of the squamous epithelium in condylomas and AIN I lesions whereas Ki67 positivity was present in all layers of the epithelium in high-grade AIN and in the lower 2/3 or all layers in low-grade areas within the high-grade lesions.…”

Postoperative Follow-Up of Anal Condylomata Acuminata in HIV-Positive Patients

“…38 showed that there are more Ki-67-positive cells in condylomata with HAIN than in those with LAIN, in anal disease. However, their most interesting result was the increased number of Ki-67 cells in LAIN areas of condylomata with HAIN.…”

“…Ki-67 expression, a cell proliferation marker, is one of the most reliable methods for establishing the cell proliferation potential in malignant and "premalignant" lesions of the uterine cervix. 37 Calore et al 38 observed an increase in the number of Ki-67-positive epithelial cells in LAIN.…”

Recidiva de lesões associadas ao HPV em pacientes HIV positivos após tratamento cirúrgico

“…1 Dentre indivíduos com Vírus da Imunodeficiência Humana (HIV) este é o agente etiológico mais frequente de doenças da região anal. [2][3][4] Sua incidência vêm aumentando desde o início da epidemia da Síndrome de Imunodeficiência Adquirida (AIDS), sugerindo que a imunodepressão é um importante fator no aparecimento do condiloma. [2][3][4] A transmissão é comumente por relação sexual, e é estimado que mais de 50% das pessoas sexualmente ativas tenham sido infectadas por HPV em algum momento de suas vidas.…”

“…[2][3][4] Sua incidência vêm aumentando desde o início da epidemia da Síndrome de Imunodeficiência Adquirida (AIDS), sugerindo que a imunodepressão é um importante fator no aparecimento do condiloma. [2][3][4] A transmissão é comumente por relação sexual, e é estimado que mais de 50% das pessoas sexualmente ativas tenham sido infectadas por HPV em algum momento de suas vidas. 5 O acometimento anal é comum e predomina em grupos com comportamento de risco para DST, antecedentes de tratamento de HPV genital ou anal prévio e portadores de prurido anal idiopático.…”