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Hernández JA, Rodríguez J, Rendón G, Trujillo LM, Beltrán MI, Mantilla C, Echeverry C, Mendoza MA, Gil M, Núñez M, Hernández M, Peralta J, Pareja R. Pelvic lymph node involvement and risk of recurrence in HPV-associated endocervical adenocarcinoma stage IA2-IB1 according to Silva's system in two Colombian cancer centers. Int J Gynaecol Obstet 2024; 166:1232-1239. [PMID: 38546455 DOI: 10.1002/ijgo.15482] [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: 11/08/2023] [Revised: 02/25/2024] [Accepted: 03/10/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To compare the pelvic lymph node involvement and risk of recurrence in patients with human papillomavirus (HPV)-associated endocervical adenocarcinoma stage IA2-IB1 undergoing hysterectomy and/or trachelectomy plus lymphadenectomy, according to Silva's classification system. METHODS A retrospective cohort study was performed in two Colombian cancer centers. The cases were classified according to the Silva classification system. Clinical, surgical, and histopathological variables were evaluated. Recurrence risk was analyzed by patterns A, B, or C. A logistic regression model was performed for tumor recurrence. The Kaplan-Meier method was used to estimate overall survival and disease-free survival (DFS). A weighted kappa was performed to determine the degree of concordance between pathologists. RESULTS A total of 100 patients were identified, 33% pattern A, 29% pattern B, and 38% pattern C. The median follow-up time was 42.5 months. No evidence of lymph node involvement was found in patients classified as A and B, while in the C pattern was observed in 15.8% (n = 6) of cases (P < 0.01). There were 7% of cases with recurrent disease, of which 71.5% corresponded to type C pattern. Patients with Silva pattern B and C had 1.22- and 4.46-fold increased risk of relapse, respectively, compared with pattern A. The 5-year DFS values by group were 100%, 96.1%, and 80.3% for patterns A, B, and C, respectively. CONCLUSION For patients with early-stage HPV-associated endocervical adenocarcinoma, the type C pattern presented more lymph node involvement and risk of recurrence compared to the A and B patterns. The concordance in diagnosis of different Silva's patterns by independents pathologists were good.
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Affiliation(s)
- Jairo Alonso Hernández
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Juliana Rodríguez
- Section of Gynecologic Oncology, Department of Gynecology and Obstetrics, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Cancer Clinical and Epidemiological Research Group, Instituto Nacional de Cancerología, Bogotá, Colombia
- Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gabriel Rendón
- Department of Gynecologic Oncology, Instituto de Cancerología Las Américas - AUNA, Medellín, Colombia
| | - Lina Maria Trujillo
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - María Islena Beltrán
- Department of Pathology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Carolina Mantilla
- Department of Pathology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Carolina Echeverry
- Department of Pathology Oncology, Clínica Las Américas - AUNA, Medellín, Colombia
| | | | - Mónica Gil
- Department of Pathology Oncology, Clínica Las Américas - AUNA, Medellín, Colombia
| | - Marcela Núñez
- Research Support and Follow-up Group, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marcela Hernández
- Health Information Systems Group, Instituto de Cancerología Clínica Las Américas, Medellín, Colombia
| | - Jonathan Peralta
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - René Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
- Clínica Astorga, Medellín, Colombia
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Rivera-Colón G, Zheng W. Endocervical neoplasia: Pathologic updates in diagnosis and prognosis. Semin Diagn Pathol 2021; 39:213-227. [DOI: 10.1053/j.semdp.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
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Talia KL, Oliva E, Rabban JT, Singh N, Stolnicu S, McCluggage WG. Grading of Endocervical Adenocarcinomas: Review of the Literature and Recommendations From the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S66-S74. [PMID: 33570864 PMCID: PMC7969159 DOI: 10.1097/pgp.0000000000000741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a lack of consensus regarding the prognostic value of grading endocervical adenocarcinomas and currently, no universally applied, validated system for grading exists. Several grading schemes have been proposed, most incorporating an evaluation of tumor architecture and nuclear morphology and these are often based on the International Federation of Gynecology and Obstetrics (FIGO) system for endometrial endometrioid carcinoma, although some schemes modify the proportion of solid tumor required to separate grades 1 and 2 from 5% to 10%. In the absence of a validated system, we endorse this approach for most human papillomavirus-associated endocervical adenocarcinomas and, based on the available evidence, recommend that tumors with ≤10% solid growth be designated grade 1, 11% to 50% solid growth grade 2 and >50% solid growth grade 3. Tumors should be upgraded in the presence of marked nuclear atypia involving the majority (>50%) of the tumor. Grading is not recommended for human papillomavirus-independent adenocarcinomas, since no validated system has been suggested and most of these neoplasms exhibit intrinsically aggressive behavior regardless of their morphologic appearance. Importantly, grading should not be performed for gastric-type adenocarcinomas, particularly as these tumors may appear deceptively "low-grade" yet still exhibit aggressive behavior. Recently devised, validated and reproducible etiology and pattern-based tumor classification systems for endocervical adenocarcinomas appear to offer more effective risk stratification than tumor grading and, in the future, these systems may render the provision of a tumor grade redundant.
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Casey L, Singh N. Metastases to the ovary arising from endometrial, cervical and fallopian tube cancer: recent advances. Histopathology 2020; 76:37-51. [PMID: 31846521 DOI: 10.1111/his.13985] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The introduction of genomic studies has enabled assessment of the clonality of synchronous tumours involving the ovary and other sites in the female genital tract in a definitive way. This has led to the abandonment of conventional approaches to primary site assignment, and the recognition that most such synchronous neoplasms are clonally related single tumours with metastatic spread, rather than independent primary tumours. These discoveries have implications for diagnostic practice, analogous to the gradual change over the last few decades in our approach to mucinous neoplasms of the ovary metastatic from the gastrointestinal tract. In this review, we first examine the routes of metastasis to the ovary, and then discuss the diagnostic and clinical implications of concurrent ovarian carcinomas arising in combination with endometrial, endocervical and tubal carcinomas. It is proposed that cases of primary low-grade endometrioid endometrial carcinoma with a secondary unilateral ovarian tumour, both with indolent characteristics, may be classified as 'FIGO stage IIIA-simulating independent primary tumours', with a comment that conservative management would be appropriate. It should be recognised that human papillomavirus-associated endocervical adenocarcinomas may result in synchronous or metachronous ovarian metastases that appear to be unrelated to the primary tumour, and that these may be managed conservatively in the absence of other sites of disease. In cases of tubo-ovarian high-grade serous carcinoma, tubal intraepithelial or contralateral adnexal involvement should count as a pelvic disease site for staging purposes.
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Affiliation(s)
- Laura Casey
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK.,Blizard Institute of Core Pathology, Queen Mary University of London, London, UK
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6
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Abstract
Endocervical adenocarcinomas (EAs) account for 25% of all primary cervical carcinomas. Approximately 85% of EAs are driven by high-risk human papillomavirus (HPV) infection, the most common of which is the so-called usual type endocervical adenocarcinomas. Non-HPV-driven subtypes harbor distinct clinicopathologic features and prognosis and have been increasingly recognized in recent years, which has led to efforts to improve classification of EA based on clinically relevant and reproducible criteria. This review discusses a recently proposed classification system, the International Endocervical Adenocarcinoma Criteria and Classification, which uniquely integrates morphology, cause/pathogenesis, and biological behavior of HPV and non-HPV-driven subtypes of EA.
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Hodgson A, Olkhov-Mitsel E, Howitt BE, Nucci MR, Parra-Herran C. International Endocervical Adenocarcinoma Criteria and Classification (IECC): correlation with adverse clinicopathological features and patient outcome. J Clin Pathol 2019; 72:347-353. [PMID: 30679193 DOI: 10.1136/jclinpath-2018-205632] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/03/2022]
Abstract
AIMS The International Endocervical Adenocarcinoma Criteria and Classification (IECC) was recently proposed as an improved method for categorising endocervical adenocarcinoma (EA) into human papillomavirus (HPV)-associated adenocarcinomas (HPVAs) and non-HPV-associated adenocarcinomas (NHPVAs). Such categorisation correlates with patient age and tumour size; however, its association with patient outcome remains to be established. METHODS Institutional cases of EA with histological material available were selected. Three gynaecological pathologists independently classified all tumours according to the IECC with consensus review used when necessary. Clinicopathologic variables were recorded for each case. RESULTS Of a total of 87 EAs, 71 (82%) were classified as HPVA and 16 (18%) as NHPVA. Among HPVA, most were usual type (51/71, 72%) followed by mucinous not otherwise specified (10/71, 14%) and invasive stratified mucin-producing carcinoma (ISMC, 8/71, 11%). Most NHPVAs were of gastric type (12/16, 71%) followed by clear cell and mesonephric (two each, 12%). Compared with HPVAs, NHPVAs were significantly associated with older age (p<0.001), larger horizontal extent (p=0.013), greater depth of invasion (p=0.003), lymphovascular space invasion (p<0.001), advanced stage (p<0.001) and invasive pattern C (p<0.001). On univariate analysis, worse disease-free survival (DFS) and disease-specific survival (DSS) correlated with NHPVA group. Among the HPVA subtypes, ISMC showed worse DFS and DSS compared with other HPVA types. CONCLUSIONS The simple morphological approach of the IECC appears to be prognostically valuable. NHPVA (in particular gastric type) and ISMC (a recently recognised subset of HPVA) have an adverse outcome and their recognition following the IECC is important. We provide further evidence to replace the current WHO classification with the IECC.
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Affiliation(s)
- Anjelica Hodgson
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Olkhov-Mitsel
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Marisa R Nucci
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Hodgson A, Park KJ, Djordjevic B, Howitt B, Nucci MR, Oliva E, Stolnicu S, Xu B, Soslow RA, Parra-Herran C. International Endocervical Adenocarcinoma Criteria and Classification: Validation and Interobserver Reproducibility. Am J Surg Pathol 2019; 43:75-83. [PMID: 29877920 PMCID: PMC6281796 DOI: 10.1097/pas.0000000000001095] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current World Health Organization (WHO) classification for endocervical adenocarcinoma (EA) is based on descriptive morphologic characteristics; however, it does not fully reflect our current knowledge of the diverse pathogenesis of cervical glandular neoplasia. A novel classification system, the International Endocervical Adenocarcinoma Criteria and Classification (IECC), which incorporates etiology and biological behavior into the morphologic scheme, has been recently proposed. We aimed to validate the IECC by assessing its interobserver reproducibility in comparison to the WHO system. A cohort of 75 EAs was reviewed independently by 7 gynecologic pathologists and categorized following IECC and WHO criteria based on hematoxylin and eosin material alone and after immunohistochemistry results for p16, PR, p53, Napsin-A, vimentin, CDX2, and GATA3 were provided. Human papillomavirus (HPV) in situ hybridization and polymerase chain reaction results were compared with consensus diagnoses. IECC was superior to WHO in terms of interobserver agreement with κ=0.46 versus 0.3, respectively, on hematoxylin and eosin review and κ=0.51 versus 0.33, respectively, with immunohistochemistry. Under the IECC, 73 (97%) of EAs had majority agreement (≥4 reviewers in agreement) whereas 42 (56%) had perfect agreement (7/7 reviewers in agreement). Conversely, WHO showed majority agreement in 56 (75%) and perfect agreement in only 7 (10%) EAs. Reproducibility was poor in HPV-related WHO types (usual κ=0.36, mucinous not otherwise specified κ=0.13, intestinal κ=0.31, villoglandular κ=0.21) and good in major HPV-unrelated categories (gastric type κ=0.63, clear cell κ=0.81, mesonephric κ=0.5). Classification as per the IECC had excellent correlation with HPV status (by RNA in situ hybridization or polymerase chain reaction). We have shown that the IECC has superior interobserver agreement compared with the WHO classification system, and that distinction between HPV-related and HPV-unrelated EA can be made with good reproducibility and excellent prediction of HPV status. WHO morphologic variants of HPV-related EA are poorly reproducible. Conversely, agreement is high among important high-risk HPV-unrelated subtypes. Thus, our results further support replacing the current WHO classification with the IECC.
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Affiliation(s)
- Anjelica Hodgson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kay J. Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bojana Djordjevic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brooke Howitt
- Department of Pathology, Stanford Medical Centre – Stanford University School of Medicine, Stanford, California
| | - Marisa R. Nucci
- Department of Pathology, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA, United States
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, United States
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Bin Xu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Spaans VM, Scheunhage DA, Barzaghi B, de Kroon CD, Fleuren GJ, Bosse T, Jordanova ES. Independent validation of the prognostic significance of invasion patterns in endocervical adenocarcinoma: Pattern A predicts excellent survival. Gynecol Oncol 2018; 151:196-201. [DOI: 10.1016/j.ygyno.2018.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022]
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The pattern is the issue: recent advances in adenocarcinoma of the uterine cervix. Virchows Arch 2018; 472:897-905. [PMID: 29404709 DOI: 10.1007/s00428-018-2312-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
In this article, we review a novel risk stratification system for endocervical adenocarcinoma, developed by an international consortium of pathologists after reviewing over 350 such tumors. Their analysis culminated in a three-tiered histopathologic system based on morphologic examination of the tumor, independent of clinical features and stage (depth of invasion). It resulted in better determination of patients' tumors and likelihood of lymph node metastasis as well as aggressive behavior. A non-destructive pattern (that in some cases was in the histologic differential diagnosis with adenocarcinoma in situ) had an indolent behavior and was labeled pattern A. The other two patterns had destructive invasion, one only focally (pattern B) while pattern C showed diffuse destructive invasion. This system can help select appropriate treatment modalities avoiding unnecessary complications. We comment on specifics of this system as well as issues in differentiation of the tumor patterns, its clinical utility and recent advances in the molecular arena.
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McCluggage WG, Oliva E. Gynaecological pathology: problematic areas, new concepts and emerging developments. Pathology 2017; 50:119-121. [PMID: 29258703 DOI: 10.1016/j.pathol.2017.11.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/19/2017] [Indexed: 11/19/2022]
Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
| | - Esther Oliva
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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