Human papillomavirus (HPV) is an oncogenic virus associated with the development of several human cancers. Primary vaginal, vulvar, and anal adenocarcinomas are rare and, to date, have rarely been shown to be associated with HPV infection. We report a series of nine HPV-related adenocarcinomas of the lower anogenital tract distal to the cervix. The tumors involved the vagina (4), anorectum (3), and vulva (2). Two of the three anorectal cases involved men. Patients presented with a vulvar or vaginal mass/nodule, painless rectal bleeding, or during screening colonoscopy. Lesions ranged in size from 3.2 to 8.4 cm. The most salient morphologic characteristic was the presence of papillary or villiform/villoglandular architecture in all cases. Tumors displayed features similar to those of usual type high-risk HPV-related endocervical adenocarcinoma, namely, mucinous or mucin-poor (pseudoendometrioid) features or a hybrid of these, with columnar cells with crowded, cigar-shaped to ovoid irregular nuclei. Mitoses (mostly apical) and apoptotic bodies were easily identified. Adenosis was present in two vaginal cases. One anal tumor featured abundant intracytoplasmic mucin that was multivacuolated in some areas imparting a "clear cell"-like appearance. All tumors were diffusely and strongly positive for p16. Seven of seven tested cases were positive for high-risk HPV by in situ hybridization or polymerase chain reaction. Follow-up information, available in five patients, revealed two local recurrences but no tumor related deaths or distant metastases. We report the first well-documented series of HPV-associated primary adenocarcinomas of the vagina, vulva, and anorectum and broaden the spectrum of HPV-related neoplasia involving the lower anogenital tract in both women and men.

中文翻译：

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一组新的女性和男性下肛门生殖道（阴道、外阴和肛门直肠）HPV 相关腺癌，类似于 HPV 相关宫颈腺癌。

人乳头瘤病毒 (HPV) 是一种致癌病毒，与多种人类癌症的发展有关。原发性阴道、外阴和肛门腺癌很少见，迄今为止，很少显示与 HPV 感染相关。我们报告了一系列 9 例 HPV 相关腺癌，发生在子宫颈远端的下肛门生殖道。肿瘤累及阴道 (4)、肛门直肠 (3) 和外阴 (2)。三例肛肠病例中有两例涉及男性。患者表现为外阴或阴道肿块/结节、无痛性直肠出血或结肠镜筛查期间。病变的大小范围为 3.2 至 8.4 厘米。最显着的形态学特征是所有病例均存在乳头状或绒毛状/绒毛腺结构。肿瘤表现出与普通型高危 HPV 相关宫颈腺癌相似的特征，即，粘液性或粘液不足（假子宫内膜样）特征或这些特征的混合，具有柱状细胞，细胞核拥挤，雪茄形至卵圆形不规则核。很容易识别有丝分裂（主要是顶端）和凋亡小体。两个阴道病例存在腺病。一个肛门肿瘤具有丰富的胞浆内粘蛋白，在某些区域呈多空泡状，呈现“透明细胞”样外观。所有肿瘤均呈弥漫性强阳性 p16。通过原位杂交或聚合酶链反应，七名受检病例中有七名呈高危 HPV 阳性。五名患者的随访信息显示有两次局部复发，但没有肿瘤相关死亡或远处转移。我们报告了第一个有据可查的系列 HPV 相关原发性阴道腺癌，外阴，