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Höhn AK, Forberger M, Alfaraidi M, Gilks CB, Brambs CE, Höckel M, Hoang L, Singh N, Horn LC. High concordance of molecular subtyping between pre-surgical biopsy and surgical resection specimen (matched-pair analysis) in patients with vulvar squamous cell carcinoma using p16- and p53-immunostaining. Gynecol Oncol 2024; 185:17-24. [PMID: 38342005 DOI: 10.1016/j.ygyno.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Vulvar squamous cell carcinoma (VSCC) can be stratified into three molecular subtypes based on the immunoexpression of p16 and p53: HPV-independent p53-abnormal (p53abn) (most common, biologically aggressive), HPV-associated, with p16-overexpression (second most common, prognostically more favourable) and more recently recognised HPV-independent p53-wildtype (p53wt) (rarest subtype, prognostically intermediate). Our aim was to determine whether molecular subtypes can be reliably identified in pre-operative biopsies and whether these correspond to the subsequent vulvectomy specimen. METHODS Matched-paired pre-surgical biopsies and subsequent resection specimen of 57 patients with VSCC were analysed for the immunohistochemical expression of p16 and p53 by performing a three-tiered molecular subtyping to test the accuracy rate. RESULTS Most cases 36/57 (63.2%) belonged to the HPV-independent (p53-abn) molecular subtype, followed by HPV-associated 17/57 (29.8%) and HPV-independent (p53wt) 4/57 (7.0%). The overall accuracy rate on biopsy was 91.2% (52/57): 97.3% for p53-abnormal, 94.1% for p16-overexpression and 50% for p16-neg/p53-wt VSCC. Incorrect interpretation of immunohistochemical p53 staining pattern was the reason for discordant results in molecular subtyping in all five cases. In one case there was an underestimation of p53 pattern (wildtype instead of abnormal/aberrant) and in one case an overestimation of the p53 staining pattern (abnormal/aberrant instead of wildtype). In 3/5 there was a "double positive" staining result (p16 overexpression and abnormal/aberrant p53 staining pattern). In that cases additional molecular workup is required for correct molecular subtyping, resulting in an overall need for molecular examination of 3/57 (3.5%). CONCLUSIONS Compared to the final resections specimen, the three-tiered molecular classification of VSCC can be determined on pre-surgical biopsies with a high accuracy rate. This enables more precise surgical planning, prediction of the response to (chemo) radiation, selection of targeted therapies and planning of the optimal follow-up strategy for patients in the age of personalised medicine.
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Affiliation(s)
- Anne Kathrin Höhn
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany.
| | - Mirjam Forberger
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany
| | - Mona Alfaraidi
- Vancouver General Hospital, University of British Columbia, Canada; Prince Sultan Military Medical City, Riyah, Saudi Arabia
| | - C Blake Gilks
- Vancouver General Hospital, University of British Columbia, Canada
| | | | - Michael Höckel
- Leipzig School of Radical Pelvic Surgery, Division of Surgical Gynecologic Oncology, University Hospital, Leipzig, Germany
| | - Lynn Hoang
- Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Naveena Singh
- Vancouver General Hospital, University of British Columbia, Canada
| | - Lars-Christian Horn
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany
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Jeffus SK, Quick CM. Coexpression of p53 and p16 in Vulvar Squamous Neoplasia. Mod Pathol 2023; 36:100319. [PMID: 37708626 DOI: 10.1016/j.modpat.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Susanne K Jeffus
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Yang H, Almadani N, Thompson EF, Tessier-Cloutier B, Chen J, Ho J, Senz J, McConechy MK, Chow C, Ta M, Cheng A, Karnezis A, Huvila J, McAlpine JN, Gilks B, Jamieson A, Hoang LN. Classification of Vulvar Squamous Cell Carcinoma and Precursor Lesions by p16 and p53 Immunohistochemistry: Considerations, Caveats, and an Algorithmic Approach. Mod Pathol 2023; 36:100145. [PMID: 36828360 DOI: 10.1016/j.modpat.2023.100145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
There is emerging evidence that vulvar squamous cell carcinoma (VSCC) can be prognostically subclassified into 3 groups based on human papillomavirus (HPV) and p53 status: HPV-associated (HPV+), HPV-independent/p53 wild-type (HPV-/p53wt), or HPV-independent/p53 abnormal (HPV-/p53abn). Our goal was to assess the feasibility of separating VSCC and its precursors into these 3 groups using p16 and p53 immunohistochemistry (IHC). A tissue microarray containing 225 VSCC, 43 usual vulvar intraepithelial neoplasia (uVIN/HSIL), 10 verruciform acanthotic vulvar intraepithelial neoplasia (vaVIN), and 34 differentiated VIN (dVIN), was stained for p16 and p53. Noncomplementary p16 and p53 patterns were resolved by repeating p53 IHC and HPV RNA in situ hybridization (ISH) on whole sections, and sequencing for TP53. Of 82 p16-positive VSCC, 73 (89%) had complementary p16 and p53 patterns and were classified into the HPV+ group, 4 (4.9%) had wild-type p53 staining, positive HPV ISH and were classified into the HPV+ group, whereas 5 (6.1%) had p53 abnormal IHC patterns (1 null, 4 overexpression), negativity for HPV ISH, and harbored TP53 mutations (1 splice site, 4 missense); they were classified as HPV-/p53abn. Of 143 p16-negative VSCC, 142 (99.3%) had complementary p53 and p16 patterns: 115 (80.4%) HPV-/p53abn and 27 (18.9%) HPV-/p53wt. One had a basal-sparing p53 pattern, positivity for HPV ISH and was negative for TP53 mutations-HPV+ category. The use of IHC also led to revised diagnoses-HSIL to dVIN (3/43), dVIN to vaVIN (8/34), and dVIN to HSIL (3/34). Overall, 215/225 VSCC (95.6%) could be easily classifiable into 3 groups with p16 and p53 IHC. We identified several caveats, with the major caveat being that "double-positive" p16/p53 should be classified as HPV-/p53abn. We propose an algorithm that will facilitate the application of p16 and p53 IHC to classify VSCC in pathology practice.
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Affiliation(s)
- Hang Yang
- Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, British Columbia, Canada
| | - Noorah Almadani
- Department of Pathology, Ministry of the National Guard - Health Affairs, and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Emily F Thompson
- Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, British Columbia, Canada
| | | | - Julia Chen
- Medical Undergraduate Program, University of British Columbia, British Columbia, Canada
| | - Julie Ho
- Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, British Columbia, Canada; Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada
| | - Janine Senz
- Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | | | - Christine Chow
- Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada
| | - Monica Ta
- Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada
| | - Angela Cheng
- Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada
| | - Anthony Karnezis
- Pathology and Laboratory Medicine, UC Davis Medical Center, California
| | - Jutta Huvila
- Department of Pathology, University of Turku, Turku University Hospital, Turku, Finland
| | - Jessica N McAlpine
- Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blake Gilks
- Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, British Columbia, Canada; Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada
| | - Amy Jamieson
- Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn N Hoang
- Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, British Columbia, Canada; Genetic Pathology Evaluation Center (GPEC) and Molecular and Advanced Pathology Core (MAPcore), British Columbia, Canada.
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Penile Squamous Cell Carcinomas in Sub-Saharan Africa and Europe: Differential Etiopathogenesis. Cancers (Basel) 2022; 14:cancers14215284. [PMID: 36358704 PMCID: PMC9654935 DOI: 10.3390/cancers14215284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
Penile squamous cell carcinomas (PSCC) are classified by the World Health Organization into two categories based on their relationship with the human papillomavirus (HPV): HPV-associated and HPV-independent. We compared a cohort of PSCC from Mozambique, a sub-Saharan country in southeast Africa with a high prevalence of HPV and HIV infection, and Spain, a country in southwestern Europe with a low prevalence of HPV and HIV, to study the distribution of the etiopathogenic categories of these tumors in both sites. A total of 79 PSCC were included in the study (28 from Mozambique and 51 from Spain). All cases underwent HPV-DNA polymerase chain reaction (PCR) testing, genotyping, and immunohistochemistry for p16 and p53. Any PSCC showing either p16 overexpression or HPV-DNA in PCR analysis was considered HPV-associated. Overall, 40/79 (50.6%) tumors were classified as HPV-associated and 39 (49.4%) as HPV-independent. The two sites showed marked differences: 25/28 (89.3%) tumors from Mozambique and only 15/51 (29.4%) from Spain were HPV-associated (p < 0.001). HPV16 was the most frequent HPV type identified in 64.0% (16/25) of the HPV-associated tumors from Mozambique, and 60.0% (9/15) from Spain (p = 0.8). On average, patients from Mozambique were almost two decades younger than those from Spain (mean age 50.9 ± 14.9 and 69.2 ± 13.3, respectively [p < 0.001]). In conclusion, significant etiopathogenic differences between PSCC in Mozambique and Spain were observed, with a remarkably high prevalence of HPV-associated tumors in Mozambique and a relatively low prevalence in Spain. These data may have important consequences for primary prevention of PSCC worldwide.
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