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N S VS, Dhanabal D, Sundaram S, V P, Balasubramanian S. Uncommon Histopathological Subtypes and Variants of Cervical Carcinoma Diagnosed at a Tertiary Care Centre: A Case Series. Cureus 2024; 16:e66783. [PMID: 39268326 PMCID: PMC11392050 DOI: 10.7759/cureus.66783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Cervical cancer ranks among the top gynaecological cancers worldwide. It is linked to lower socioeconomic status and high human papillomavirus (HPV) prevalence. This is a series of six cervical carcinoma cases analysed from 2021 to 2023 at our tertiary care centre to identify rare subtypes of cervical carcinoma. We document rare subtypes, which include glassy cell carcinoma, small cell neuroendocrine carcinoma, papillary squamous-transitional variant, basaloid squamous cell carcinoma and serous carcinoma of the uterine cervix. Immunohistochemistry (IHC) was helpful in confirmation of the subtypes and in diagnosing HPV-associated cases. Materials and methods This case series comprises six cases, including rare subtypes and variants of cervical carcinoma histopathologically diagnosed by the Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, between 2021 and 2023. The demographic profile and patient details were obtained from the hospital information system and archival case files after obtaining informed consent from the patients. The H&E and relevant IHC slides along with histopathology reports of the included cases were analysed and studied. Results This series includes six cases of rare subtypes of cervical carcinoma, comprising glassy cell carcinoma, small cell neuroendocrine carcinoma, papillary squamous-transitional variant, basaloid squamous cell carcinoma (SCC), and serous carcinoma. Each subtype displays distinct clinicopathological features, emphasizing the need for specific diagnostic and treatment approaches, which are crucial in improving patient survival. Conclusion Six rare subtypes and variants of cervical carcinoma have been discussed in this case series, after correlating with histopathology reports and clinical and radiological findings. Understanding the histopathological characteristics of these rarer subtypes is essential for accurate diagnosis and timely intervention. This series highlights the importance of comprehensive screening strategies, early diagnosis and awareness of rarer subtypes and variants of cervical carcinoma among healthcare professionals. These factors can tailor therapeutic options and improve patient outcomes.
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Affiliation(s)
- Veda Samhitha N S
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Divya Dhanabal
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sandhya Sundaram
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Pavithra V
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Vrdoljak-Mozetič D, Štemberger-Papić S, Verša Ostojić D, Rubeša R, Klarić M, Eminović S. Pitfalls in Gynecological Cytology: Review of the Common and Less Frequent Entities in Pap Test. Acta Cytol 2024; 68:281-298. [PMID: 38834045 DOI: 10.1159/000539637] [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: 12/05/2023] [Accepted: 05/31/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Pitfalls in Pap test could be defined as false positive, false negative, or underdiagnosed results which can lead to unnecessary diagnostic procedures or delayed and inadequate treatment. It can be a consequence of misinterpretation of certain morphological entities which are described in this paper. SUMMARY The paper presents an overview of the morphological features and look-alikes of the common sources of pitfalls such as atrophy, repair, intrauterine device change, tubal metaplasia, hyperchromatic crowded groups, and radiation changes. Rare causes of pitfalls such as Arias-Stella changes, pemphigus, tumor diathesis per se, rare types of cervical cancer, including verrucous and papillary squamous cell cancer, gastric type, and endometrioid adenocarcinoma are also described. KEY MESSAGES The awareness of pitfalls in cervical cytology is important for cytopathologists and clinicians to avoid future errors. Review of Pap tests with erroneous diagnosis is important for quality control in cytology laboratory, and it must be considered an educational- and experience-building procedure. Cytopathologist should not pull back in significant diagnoses, especially in human papillomavirus-negative cases.
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Affiliation(s)
- Danijela Vrdoljak-Mozetič
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Snježana Štemberger-Papić
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Damjana Verša Ostojić
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Roberta Rubeša
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Marko Klarić
- Clinic of Gynecology and Obstetrics, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Senija Eminović
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Stolnicu S, Allison D, Patrichi A, Flynn J, Iasonos A, Soslow RA. Invasive Squamous Cell Carcinoma of the Cervix: A Review of Morphological Appearances Encountered in Human Papillomavirus-associated and Papillomavirus-independent Tumors and Precursor Lesions. Adv Anat Pathol 2024; 31:1-14. [PMID: 37638549 PMCID: PMC10841279 DOI: 10.1097/pap.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Cervical cancer is the fourth most common cancer among women globally. Historically, human papillomavirus (HPV) infection was considered necessary for the development of both precursor and invasive epithelial tumors of the cervix; however, studies in the last decade have shown that a significant proportion of cervical carcinomas are HPV-independent (HPVI). The 2020 World Health Organization (WHO) Classification of Female Genital Tumors separates both squamous cell carcinomas (SCCs) and endocervical adenocarcinomas (ECAs) by HPV status into HPV-associated (HPVA) and HPVI tumors. The classification further indicates that, in contrast to endocervical adenocarcinomas, HPVI and HPVA SCCs cannot be distinguished by morphological criteria alone and suggests that HPV testing or correlates thereof are required for correct classification. Moreover, while HPVA SCC precursor lesions (ie, high-grade squamous intraepithelial lesion) are well known and characterized, precursors to HPVI SCCs have only been described recently in a small number of cases. We studied 670 cases of SCCs from the International Squamous Cell Carcinoma Project (ISCCP) to analyze the reproducibility of recognition of invasive SCC growth patterns, presence of lymphovascular space invasion, tumor grade, and associations with patient outcomes. Consistent with previous studies, we found histologic growth patterns and tumor types had limited prognostic implications. In addition, we describe the wide morphologic spectrum of HPVA and HPVI SCCs and their precursor lesions, including tumor growth patterns, particular and peculiar morphologic features that can lead to differential diagnoses, and the role of ancillary studies in the diagnosis of these tumors.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology “Gh E Palade” of Targu Mures, Targu Mures, Romania
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrei Patrichi
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology “Gh E Palade” of Targu Mures, Targu Mures, Romania
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cui C, Chen Z, Luo L, Zeng J, Sun X, Sui L, Xu C, Fu Z, Cong Q. Value of loop electrosurgical excision procedure conization and imaging for the diagnosis of papillary squamous cell carcinoma of the cervix. Front Oncol 2023; 13:1166818. [PMID: 37476381 PMCID: PMC10354288 DOI: 10.3389/fonc.2023.1166818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Background Loop electrosurgical excision procedure (LEEP) conization and hysterectomy are performed for some patients with papillary squamous cell carcinoma (PSCC), whereas only hysterectomy is performed for others. We aimed to determine the optimal management for PSCC. Methods Patients diagnosed with PSCC by colposcopy-directed biopsy between June 2008 and January 2020 who underwent LEEP conization and hysterectomy or only hysterectomy at our hospital were enrolled. Results of cervical cytology, high-risk human papillomavirus testing, transvaginal sonography, pelvic magnetic resonance imaging, LEEP, hysterectomy, and pathology testing of colposcopy-directed biopsy samples were analyzed. Results A total of 379 women were diagnosed with PSCC by colposcopy-directed biopsy; 174 underwent LEEP before hysterectomy and 205 underwent only hysterectomy. Patients underwent and did not undergo LEEP were aged 47 ± 11 years and 52 ± 11 years, respectively. Among women who underwent LEEP, the agreement between LEEP and hysterectomy pathology was 85.1%. For women who underwent only hysterectomy, the agreement between preoperative clinical staging and pathological staging after hysterectomy was 82.4%. For patients with preoperative imaging indicative of malignancy, the accuracy of LEEP for diagnosing and staging PSCC was 88.5%, whereas for the hysterectomy-only group, it was 86.2%. For patients without malignancy detected with imaging, the accuracy of LEEP for diagnosing and staging PSCC was 81.6%; however, for those who did not undergo LEEP, it was 70.0%. Conclusion For women diagnosed with PSCC by colposcopy-directed biopsy, LEEP conization is necessary for an accurate diagnosis when imaging does not indicate cancer; however, LEEP is not necessary when imaging indicates cancer.
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Affiliation(s)
- Can Cui
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ziren Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lingxiao Luo
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jianping Zeng
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaoyi Sun
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Long Sui
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Congjian Xu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Zhongpeng Fu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
| | - Qing Cong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China
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Arab M, Pirastehfar Z, Afshar Moghaddam N, Raoufi M. Papillary squamotransitional cell carcinoma of the uterine cervix: A rare case report. Clin Case Rep 2023; 11:e7508. [PMID: 37305882 PMCID: PMC10256865 DOI: 10.1002/ccr3.7508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Key Clinical Message Although papillary squamotransitional cell carcinoma is an uncommon variant of cervical squamous cell carcinoma, due to the complex papillary structure and the challenge in detecting stromal invasion, its timely diagnosis and treatment are very important. Abstract Papillary squamotransitional cell carcinoma (PSTCC) is extremely rare and presents with a spectrum of morphologies. PSTCC may present as an in situ tumor with or without an invasion, but usually, it displays both features. Here we report a 60-year-old woman, diagnosed with PSTCC of the uterine cervix.
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Affiliation(s)
- Maliheh Arab
- Department of Gyneco‐oncology, Imam Hossein Medical CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Zanbagh Pirastehfar
- Department of Obstetrics and Gynecology, School of Medicine, Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Noushin Afshar Moghaddam
- Department of Pathology, School of Medicine, Imam Hossein Medical CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Masoomeh Raoufi
- Department of Radiology, School of Medicine, Imam Hossein Medical CenterShahid Beheshti University of Medical SciencesTehranIran
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Papillary Squamotransitional Cell Carcinoma of the Uterine Cervix with Atypical Presentation: A Case Report with a Literature Review. Medicina (B Aires) 2022; 58:medicina58121838. [PMID: 36557040 PMCID: PMC9785399 DOI: 10.3390/medicina58121838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Cervical cancer is the fourth most prevalent malignancy and the fourth leading cause of cancer-related death in women around the world. Histologically, squamous cell carcinoma (SCC) is the most common form of cervical cancer. SCC has several subtypes, and one of the rarest is papillary squamotransitional cell carcinoma (PSCC). In general, PSCC is believed to have a similar course and prognosis to typical SCC, with a high risk of late metastasis and recurrence. Case report: We discuss the case of a 45-year-old patient diagnosed with PSCC who was admitted to our department in December 2021. The clinical manifestations were pelvic discomfort and lymphadenopathy throughout the body. On admission, all laboratory values, with the exception of C-Reactive Protein (CRP) at 22.35 mg/L and hemoglobin (HGB) at 87.0 g/L, were normal. The clinical and ultrasound examination revealed a painful formation with indistinct borders in the right portion of the small pelvis. Following dilation and curettage, a Tru-Cut biopsy of the inguinal lymph nodes was performed. The investigation histologically indicated PSCC. MRI of the small pelvis showed an endophytic tumor in the cervix with dimensions of 35/26 mm and provided data for bilateral parametrial infiltration; a hetero-intensive tumor originating from the right ovary and involving small intestinal loops measuring 90/58 mm; and generalized lymphadenopathy and peritoneal metastases in the pouch of Douglass. The FIGO classification for the tumor was IVB. The patient was subsequently referred for chemotherapy by the tumor board's decision. Discussion: Despite the generally good prognosis of SCC, PSCC is a rare and aggressive subtype. It is usually diagnosed at an advanced stage and has a poor prognosis. Conclusions: PSCC is a rare subtype of SCC, and its diagnosis and treatment are challenging.
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Woo HY, Kim HS. Local and Metastatic Relapses in a Young Woman with Papillary Squamous Cell Carcinoma of the Uterine Cervix. Diagnostics (Basel) 2022; 12:diagnostics12030599. [PMID: 35328152 PMCID: PMC8946994 DOI: 10.3390/diagnostics12030599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023] Open
Abstract
Papillary squamous cell carcinoma (PSCC) is a rare histological type of cervical carcinoma whose biological behavior has not been fully established. A 33-year-old woman with an exophytic cervical mass underwent radical hysterectomy and bilateral pelvic lymph node dissection. Histological examination of the tumor revealed numerous papillary fronds lined by atypical stratified squamous cells, resembling high-grade squamous intraepithelial lesions or urothelium. She was diagnosed with stage IB1 PSCC. Three months postoperatively, a 5.7 cm vaginal stump mass was detected. She received chemoradiotherapy, which helped her achieve a complete response. However, nine months postoperatively, she developed pelvic lymph node metastases. We present a rare case of recurrent cervical PSCC in a young woman. PSCC of the uterine cervix can recur rapidly within just a few months and become aggressive, as in the present case.
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Affiliation(s)
- Ha Young Woo
- Department of Pathology, National Cancer Center, Goyang 10408, Korea;
- Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence:
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Sone K, Inoue F, Taguchi A, Hinata M, Ikemura M, Miyamoto Y, Michihiro T, Ohno T, Iriyama T, Mori-Uchino M, Tsuruga T, Mishima M, Osuga Y. A case of difficult-to-diagnose non-invasive papillary squamous cell carcinoma of the uterine cervix infected with human papilloma virus 6: A diagnostic pitfall. Clin Case Rep 2021; 9:e04905. [PMID: 34631088 PMCID: PMC8489388 DOI: 10.1002/ccr3.4905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023] Open
Abstract
We encountered HPV6-positive cervical papillary squamous cancer (PSCC) that was difficult to diagnose. The case was initially diagnosed and treated for condyloma. To the best of our knowledge, this is the first report of HPV6 infection in PSCC.
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Affiliation(s)
- Kenbun Sone
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Futaba Inoue
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Munetoshi Hinata
- Department of pathology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Masako Ikemura
- Department of pathology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Tanikawa Michihiro
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | | | - Takayuki Iriyama
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Mayuyo Mori-Uchino
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Misako Mishima
- Department of pathology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology Graduate School of Medicine The University of Tokyo Tokyo Japan
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Zhang W, Gao Y, Zhang W, Lin Z, Bi H, Zhu L. Survival outcomes and prognostic factors of papillary serous adenocarcinoma and papillary squamous cell carcinoma of the uterine cervix. J OBSTET GYNAECOL 2021; 42:1233-1238. [PMID: 34565276 DOI: 10.1080/01443615.2021.1945559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this retrospective population-based study was to investigate the survival outcomes and prognostic factors of patients with the two cervical carcinomas. A cohort of patients diagnosed with papillary serous adenocarcinoma of the uterine cervix (PSAC) and papillary squamous cell carcinoma (PSCC) between 1973 and 2015 were drawn from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox proportional hazards survival regression analysis. The 5-year and 10-year OS rates were 38.4 and 33.1% for PSAC and 64.6 and 50.8% for PSCC, respectively. The 2-year and 5-year CSS rates were 60.6 and 45.9% for PSAC and 79.6 and 69.0% for PSCC, respectively. Patients with PSCC survive longer than PSAC patients and have other well-described prognostic factors for improved survival rates, including an early cancer stage, a younger patient age and standardised surgery.Impact statementWhat is already known on this subject? Papillary serous adenocarcinoma of the uterine cervix (PSAC) and papillary squamous cell carcinoma (PSCC)are both very rare subtypes of cervical carcinomas.What do the results of this study add? This retrospective population-based analysis has evaluated the survival outcomes and prognostic indicators of patients with PSAC and PSCC.What the implications are of these findings for clinical practice and/or further research? Knowing the survival outcomes and prognostic indicators of PSAC and PSCC patients, we can better follow up patients.
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Affiliation(s)
- Wei Zhang
- Department of Gynecology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, P. R. China
| | - YuTao Gao
- Department of Gynecology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong, P. R. China
| | - WenQue Zhang
- Department of Gynecology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, P. R. China
| | - ZhiHong Lin
- Department of Gynecology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, P. R. China
| | - HaiYan Bi
- Department of Gynecology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, P. R. China
| | - LiBo Zhu
- Department of Gastroenterology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, P. R. China
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Papillary Squamous Cell Carcinoma of the Uterine Cervix: Biopsy Samples Frequently Underrepresent the Presence of Stromal Invasion. Int J Gynecol Pathol 2020; 40:408-412. [PMID: 33323853 DOI: 10.1097/pgp.0000000000000728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma, histologically characterized by thin or broad papillae lined by epithelium showing the features of high-grade squamous intraepithelial lesion. Given the exophytic nature of these neoplasms, the diagnosis, assessment and quantification of invasion may be difficult in small biopsies. The goal of this study was to determine the presence and extent of cervical stromal invasion by comparing biopsy samples with excisional specimens in a cohort of patients diagnosed with papillary squamous cell carcinoma. Cases were identified from the surgical pathology files between the years 2003 and 2018 and only cases in which the patients underwent an excisional procedure following the diagnostic biopsy were included. Eighteen cases were identified. Patients age ranged 21 to 72 yr (mean: 46.2 yr). Review of the initial, presurgical biopsies showed that 17/18 (94%) patients had no evidence of stromal invasion. In the surgical excision specimens (2 cone biopsies, 1 loop electrosurgical excision procedure, and 15 hysterectomies), 13 cases (76.5%) showed invasive squamous cell carcinoma. Tumor sizes ranged 1.0 to 6.1 cm; stromal invasion ranged in depth 0.2 to 2.2 cm (median: 1.2), and in horizontal length 0.3 to 4.0 cm (median: 2.01). Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma of the cervix that may impose some diagnostic difficulties in small biopsies. Our findings demonstrated that the significant majority of cases might only show the presence of invasive cancer in excisional samples. Awareness of this data is important to guide proper management and avoid under-treatment.
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Gitas G, Ertan K, Rody A, Baum S, Tsolakidis D, Alkatout I. Papillary squamotransitional cell carcinoma of the uterine cervix: a case report and review of the literature. J Med Case Rep 2019; 13:319. [PMID: 31655625 PMCID: PMC6815390 DOI: 10.1186/s13256-019-2217-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background Papillary squamotransitional cell carcinoma of the uterine cervix is a rare neoplasm, a subtype of transitional cervical carcinoma that appears to be a variation of squamous cervical carcinoma. It has a disposition toward metastasis at an advanced stage and local recurrence. Owing to the difficulty of illustrating the invasion histologically, misdiagnosis is likely to affect the patient’s prognosis. Case presentation We present a case report of an 81-year-old Caucasian patient with squamotransitional cell carcinoma with unusual clinical behavior that was primarily thought to be ovarian cancer. According to the clinical examination and radiologic imaging, the patient had no vaginal bleeding and a normal cervix. Nevertheless, the tumor was already metastasized at the retroperitoneal tissue and at the right ovary. Computed tomography-guided biopsy of the right adnexa gave no further clarification. Although the tumor resembled urothelial cancer, this diagnosis was dismissed because of the results of immunohistochemistry analysis with CK7+, CK5+, and CK20−. Because of the differential diagnosis of ovarian cancer, we decided in favor of an exploratory surgical approach. Hysterectomy with bilateral adnexectomy, extensive retroperitoneal tumor debulking, and infragastric omentectomy was performed by laparotomy. Histopathology revealed a squamotransitional cervical cancer as the primary tumor with a tumor stage of pT3b, pN1 (1/2), V0, RX, G2, corresponding to International Federation of Gynecology and Obstetrics stage IIIB. Conclusions As far as we are aware, this is the first report of papillary squamotransitional cell carcinoma of the uterine cervix metastatic to the ovary without vaginal bleeding and with a clinically and radiologically unsuspicious cervix. Physicians should always contemplate papillary squamotransitional cell carcinoma of the uterine cervix in unclear cases with ovarian metastasis, especially if the histology indicates a transitional cancer (CK7+ and CK20−), before proceeding with treatment. More cases are needed to illuminate the clinical characteristics and categorization of papillary squamotransitional cell carcinoma of the uterine cervix.
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Affiliation(s)
- Georgios Gitas
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Kubilay Ertan
- Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Sascha Baum
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany
| | - Dimitrios Tsolakidis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Kiel, Arnold-Heller-Strasse 3, House 24, 24105, Kiel, Germany.
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Lee Y, Choi Y, Lee K, Lee Y, Kim H, Choe JY, Lee HS, Kim YB, Kim H. Liquid-Based Cytology Features of Papillary Squamotransitional Cell Carcinoma of the Uterine Cervix. J Pathol Transl Med 2019; 53:341-344. [PMID: 31237998 PMCID: PMC6755647 DOI: 10.4132/jptm.2019.06.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yangkyu Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Younghwa Choi
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kiryang Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youngeun Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Young Choe
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Stewart CJ, Leung YC, Chaudry Z, Koay M, Naran A, Plunkett M, Ruba S, Snowball B, Soma A. Evaluation of pathology review at gynaecological oncology multidisciplinary team meetings: a 5-year prospective analysis of cases with major diagnostic discordance. Pathology 2019; 51:353-361. [DOI: 10.1016/j.pathol.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 02/07/2023]
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Lima M, Rio G, Horta M, Cunha TM. Primary vaginal malignancies: a single oncology centre experience. J OBSTET GYNAECOL 2019; 39:827-832. [DOI: 10.1080/01443615.2019.1579786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mariana Lima
- Department of Radiology, Centro Hospitalar de Lisboa Central (Hospital de Santo António dos Capuchos), Alameda de Santo António dos Capuchos, Lisboa, Portugal
| | - Gisela Rio
- Department of Radiology, Hospital de Braga, Braga, Portugal
| | - Mariana Horta
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisboa, Portugal
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Zhang X, Ding J, Tao X, Qian H, Hua K. Diagnosis and treatment of cervical papillary squamous cell carcinoma with unknown depth of stromal invasion. Int J Gynaecol Obstet 2017; 138:190-193. [PMID: 28504849 DOI: 10.1002/ijgo.12215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/18/2017] [Accepted: 05/12/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Xuyin Zhang
- Department of Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Shanghai China
| | - Jingxin Ding
- Department of Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Shanghai China
| | - Xiang Tao
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Shanghai China
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Huijun Qian
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Shanghai China
- Department of Radiology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Keqin Hua
- Department of Gynecology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Shanghai China
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Turker LB, Gressel GM, Abadi M, Frimer M. Papillary squamous cell carcinoma of the cervix: Two cases and a review of the literature. Gynecol Oncol Rep 2016; 18:18-21. [PMID: 27790636 PMCID: PMC5072143 DOI: 10.1016/j.gore.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Papillary squamous cell carcinoma of the cervix (PSCC) is a rare and distinct form of cervical carcinoma. Detecting stromal invasion on biopsy is difficult due to the papillary growth of the tumor. Here we present two cases that highlight the diagnostic and clinical challenges of PSCC. Case 1 A 50-year-old woman found to have carcinoma on a routine pap-smear. The patient was diagnosed with PSCC on colposcopic biopsy and underwent a radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection. Her final pathology demonstrated PSCC with no evidence of stromal invasion. At her 3-month follow up visit, she was noted to have a tumor recurrence at the vaginal cuff, again with no stromal invasion. She is currently undergoing definitive radiation therapy with sensitizing cisplatin. Case 2 An 82-year-old woman presented with post-menopausal bleeding and was found to have an exophytic mass. Biopsies were taken and showed PSCC with no stromal invasion identified. She underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Final pathology indicated no invasion. She is currently being followed for persistent vaginal dysplasia. Conclusion PSCC is a rare tumor that has previously been described as less aggressive than classical squamous cell carcinoma. These two cases demonstrate the complex behavior of the disease. Case 1 highlights that PSCC may recur even when stromal invasion cannot be confirmed pathologically. Describes two distinct cases of papillary squamous cell carcinoma (PSCC). The lack of stromal invasion continues to define aggressive tumor behavior. A multi-disciplinary approach is necessary in the treatment of patients with PSCC.
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Affiliation(s)
- Lauren B Turker
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Jacobi Medical Center, United States; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, United States
| | - Gregory M Gressel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Jacobi Medical Center, United States; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, United States
| | - Maria Abadi
- Department of Pathology, Albert Einstein College of Medicine, Jacobi Medical Center, United States
| | - Marina Frimer
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Jacobi Medical Center, United States; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, United States
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Papillary Squamotransitional Cell Carcinoma of the Uterine Cervix: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2016; 2016:7107910. [PMID: 27656303 PMCID: PMC5021459 DOI: 10.1155/2016/7107910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/14/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Papillary squamotransitional cell carcinoma (PSTCC) is an uncommon histopathological variant of squamous cell carcinoma (SCC) of the uterine cervix, which occurs in postmenopausal women. Presentation of Case. Herein, we describe a case of a 63-year-old woman who presented with 4-month history of postmenopausal vaginal bleeding. Vaginal examination revealed a fragile lesion of size 1 × 1 cm invading left posterior vaginal fornice and parametrium. Biopsy showed the presence of papillae containing fibrovascular cores lined by multilayered atypical epithelial cells resembling squamous and transitional cell epithelium, confirming the diagnosis of PSTCC of the uterine cervix. After staging work-up she was staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system 2009 as FIGO IIB, and she was started on extended field concurrent chemoradiation. Discussion. PSTCC of the uterine cervix is an extremely rare and aggressive entity. PSTCC is often characterized by the presence of papillary structures with prominent fibrovascular cores. PSTCC of the uterine cervix should be differentiated from transitional cell carcinoma, squamous papilloma, papillary adenocarcinoma, and cervical intraepithelial neoplasia with papillary features. Conclusion. PSTCC of the uterine cervix is a diagnostic challenge; further studies regarding the mechanism underlying the development of PSCC are warranted.
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Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix. BMC Cancer 2014; 14:784. [PMID: 25348708 PMCID: PMC4232646 DOI: 10.1186/1471-2407-14-784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022] Open
Abstract
Background Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior. Methods We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis. Results Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived. Conclusions MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-784) contains supplementary material, which is available to authorized users.
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Anand M, Deshmukh SD, Gulati HK. Papillary squamotransitional cell carcinoma of the uterine cervix: A histomorphological and immunohistochemical study of nine cases. Indian J Med Paediatr Oncol 2013; 34:66-71. [PMID: 24049289 PMCID: PMC3764746 DOI: 10.4103/0971-5851.116177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Papillary squamotransitional cell carcinoma (PSCC) is a distinctive subcategory of squamous cell carcinoma of the uterine cervix. It has a propensity for local recurrence and late metastasis. Histologically, it can be misinterpreted as transitional cell carcinoma, or other papillary lesions of the cervix including squamous papilloma, verrucous carcinoma or cervical intraepithelial neoplasia grade 3 with papillary configuration. MATERIALS AND METHODS Nine cases of PSCC of the uterine cervix were diagnosed on a cervical biopsy specimen on routine hematoxylin and eosin (H and E) stained sections. Their clinic-morphological features were analyzed. The cases were further evaluated immunohistochemically by cytokeratin 7 (CK7), cytokeratin 20 (CK20), p53 and Ki-67. RESULTS The patients ranged in age from 35 years to 75 years; with abnormal uterine bleeding being the most common clinical presentation. All the cases showed papillary architecture with fibrovascular cores lined by multilayered atypical epithelium. Three cell types were observed: Clear, intermediate and basaloid. Stromal invasion was seen in five cases, whereas in the remaining four cases, the biopsy specimen was too superficial to definitely assess invasion. Immunohistochemically, eight cases were CK7(+)/CK20(-) and one case was CK7(-)/CK20(-). All nine cases showed nuclear accumulation of mutant p53. Moderate and high proliferative activity was observed in two and seven cases, respectively. Five of patients for whom follow-up information was available underwent radical hysterectomy and two of them were disease free 18 months following treatment. CONCLUSION PSCC of the uterine cervix are a clinicomorphologically distinct group of cervical lesions that display a morphologic spectrum. They are potentially aggressive malignant tumors that should be distinguished from transitional cell carcinoma and other papillary lesions of the uterine cervix.
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Affiliation(s)
- Mani Anand
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
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Fichtali K, Khadija C, Rajae B, Aboulfalah A, Asouki H, Soummani A, Belaabidia B. Papillary Squamous Cell Carcinoma of the Uterine Cervix with Negative HPV: Report of a Case and Literature Review. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karima Fichtali
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Chaker Khadija
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Bennani Rajae
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Abderrahim Aboulfalah
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Hamid Asouki
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Abderraouf Soummani
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
| | - Badia Belaabidia
- Service of Gynaecology Obstetrics Centre, Hospitalier Universitaire Med VI Marrakech, Marrakech, Morocco
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Niederle B, Rauthe S, Engel JB, Krockenberger M, Dietl J, Honig A. Papillary squamotransitional cell carcinoma of the vagina. J Obstet Gynaecol Res 2011; 37:1851-5. [PMID: 21917071 DOI: 10.1111/j.1447-0756.2011.01636.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case of a papillary squamotransitional cell carcinoma (PSTCC) of the vagina with a follow-up of 3 years is presented here. The characteristics of this case support a squamous rather than urothelial origin of this rare entity. Unlike its counterparts in the cervix uteri, the clinical behavior of vaginal PSTCC is more favorable than squamous cell carcinoma. Histological and clinical features are compared to those of previously described cases of vaginal and cervical PSTCC.
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Affiliation(s)
- Bernhard Niederle
- Departments of Gynecology and Obstetrics, University Hospital, Wuerzburg, Germany.
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Patrelli TS, Silini EM, Berretta R, Thai E, Gizzo S, Bacchi Modena A, Nardelli GB. Squamotransitional Cell Carcinoma of the Vagina: Diagnosis and Clinical Management. Pathol Oncol Res 2010; 17:149-53. [DOI: 10.1007/s12253-010-9280-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/18/2010] [Indexed: 11/24/2022]
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Papillary squamous cell carcinoma of the head and neck: frequent association with human papillomavirus infection and invasive carcinoma. Am J Surg Pathol 2009; 33:1720-4. [PMID: 19745700 DOI: 10.1097/pas.0b013e3181b6d8e6] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Papillary squamous cell carcinoma (SCC) is an uncommon variant of SCC in the upper aerodigestive tract. It is most frequently located in the larynx, oropharynx, and sinonasal tract, and is more common in older men. Because of its complex exophytic papillary architecture, histologic assessment of underlying invasion can be challenging. Risk factors and pathogenesis are unclear. We reviewed 31 papillary SCCs of the upper aerodigestive tract seen at our institution over a 17-year period with respect to p16 immunoreactivity and human papillomavirus (HPV) status. Twelve papillary SCCs were associated with invasive SCC in their disease course. In our study, more than two-thirds of papillary SCCs in the upper aerodigestive tract were immunoreactive with antibody to p16 and 68% of those lesions had identifiable high-risk HPV by in situ hybridization. As with other HPV-associated SCCs of the upper aerodigestive tract, the majority of HPV-associated papillary SCCs are oropharyngeal (base of tongue and palatine tonsils), although both sinonasal and laryngeal tumors were also associated with infection (67% and 33% of cases, respectively). Given the better prognosis of HPV-associated SCCs of the upper aerodigestive tract, it may be prudent to report the p16 and HPV status of these tumors when they are encountered.
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Gao Z, Bhuiya T, Falkowski O. Papillary squamotransitional cell carcinoma of the vagina: a case report and review of literature. J OBSTET GYNAECOL 2009; 25:94-6. [PMID: 16147722 DOI: 10.1080/01443610400025804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Z Gao
- Department of Pathology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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Parikh JH, Barton DPJ, Ind TEJ, Sohaib SA. MR imaging features of vaginal malignancies. Radiographics 2008; 28:49-63; quiz 322. [PMID: 18203930 DOI: 10.1148/rg.281075065] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary vaginal malignancies are rare, accounting for only 1%-2% of all gynecologic malignancies. Squamous cell carcinoma makes up about 85% of primary vaginal malignancies. This tumor characteristically arises from the posterior wall of the upper third of the vagina. The main patterns of disease are an ulcerating or fungating mass or an annular constricting lesion. At magnetic resonance (MR) imaging, squamous cell carcinoma has intermediate signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumors that account for the remaining 15% of primary vaginal malignancies are adenocarcinoma, melanoma, and sarcomas. The signal intensity characteristics on MR images correlate with the histologic subtypes and reflect the MR imaging appearances of these histologic subtypes elsewhere in the body. Secondary malignancy of the vagina is far more frequent than primary vaginal malignancy. Most vaginal metastases occur by means of direct local spread from the cervix, uterus, or rectum. The MR imaging appearances of these metastases reflect the MR imaging appearances of the primary tumor.
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Affiliation(s)
- Jyoti H Parikh
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom
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Kokka F, Verma M, Singh N, Faruqi A, Yoon J, Reynolds K. Papillary squamotransitional cell carcinoma of the uterine cervix: report of three cases and review of the literature. Pathology 2007; 38:584-6. [PMID: 17393993 DOI: 10.1080/00313020601023922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Odida M. Papillary squamous cell carcinoma of the cervix in Uganda: a report of 20 cases. Afr Health Sci 2006; 5:291-4. [PMID: 16615837 PMCID: PMC1831954 DOI: 10.5555/afhs.2005.5.4.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND Non-glandular papillary carcinoma of the cervix are uncommon tumours. In Uganda where cervical carcinoma is very common, no cases of papillary squamous cell carcinoma of the cervix has been reported. OBJECTIVES To ascertain the occurrence and describe the clinicopathological features of papillary squamous cell carcinoma of the cervix in Uganda. STUDY DESIGN Retrospective review of histologically diagnosed cases of squamous cell carcinoma of cervix with papillary structures. METHODS Retrospective review of cases of cervical carcinoma diagnosed in the Pathology Department, Makerere University from 1968 to 1973 was done. Cases with features of squamous differentiation and forming papillary pattern were then selected. RESULTS Twenty cases were encountered and the ages of the patients ranged from 22 to 70 years (mean 46.6 years). Histologically, the tumours had thin to broad fibrovascular cores covered by multilayered squamous epithelium. In five cases, there were areas with very delicate fibrovascular cores covered by monolayered epithelial cells. CONCLUSION The results of this study show that in Uganda, papillary squamous cell carcinoma of the cervix does occur and is predominantly a disease of older women. The results also confirm that papillary squamous cell carcinoma is a distinct subtype with some variants, and support the hypothesis that squamous cell carcinoma of the cervix is heterogeneous group of tumuors.
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Affiliation(s)
- Michael Odida
- Department of Pathology, Faculty of Medicine, Makerere University, Kampala, Uganda.
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Drew PA, Hong B, Massoll NA, Ripley DL. Characterization of Papillary Squamotransitional Cell Carcinoma of the Cervix. J Low Genit Tract Dis 2005; 9:149-53. [PMID: 16044054 DOI: 10.1097/01.lgt.0000172325.78429.1e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Does papillary squamotransitional cell carcinoma (PSTCC) behave differently from conventional squamous cell carcinoma of the cervix and does PSTCC have true transitional cell differentiation? MATERIALS AND METHODS Twenty cases of PSTCC were identified from archival files. Clinical data were compiled. Immunoperoxidase stains for uroplakin III, p63 and p16 were performed on available tissue blocks. RESULTS Patients ranged in age from 27 to 85 years. Twelve patients were FIGO Stage I, 4 were Stage II, and 2 were Stage III. Thirteen patients had clinical follow-up ranging from 5 to 132 months. Three patients subsequently had more extensive disease than initial clinical staging indicated. Nine patients had no tumor progression, three had local recurrence and one had metastatic disease. Eight cases were strongly immunoreactive for p63 and p16 and 14 were negative for uroplakin III. CONCLUSIONS PSTCC lacks true transitional cell differentiation and probably shares similar clinicopathologic features with conventional cervical squamous cell carcinoma.
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Affiliation(s)
- Peter A Drew
- Department of Pathology, University of Florida College of Medicine, PO Box 100275, Gainesville, FL 32610, USA.
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Mirhashemi R, Ganjei-Azar P, Nadji M, Lambrou N, Atamdede F, Averette HE. Papillary squamous cell carcinoma of the uterine cervix: an immunophenotypic appraisal of 12 cases. Gynecol Oncol 2003; 90:657-61. [PMID: 13678741 DOI: 10.1016/s0090-8258(03)00329-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to evaluate the role of human papillomavirus (HPV) in the pathogenesis of papillary squamous cell carcinoma (PSCC) of the cervix and to determine cell proliferative activity and p53 abnormalities in these rare variants of cervical cancer. METHODS Twelve examples of PSCC of the cervix were diagnosed between 1990 and 1999. Formalin-fixed paraffin sections of each tumor were stained by immunoperoxidase method using antibodies to p53 gene product (CM-10) and Ki-67 (MIB-1). In situ hybridization for HPV DNA (ENZO) was used to detect specific sequences of DNA shared by most types of genital HPV, followed by confirmatory PCR analysis. The nuclear staining for Ki-67 was graded as minimal (<10% of cells), moderate (between 10 and 50% of cells), and high (>50% of cells). RESULTS Fifty-percent of the tumors showed presence of HPV DNA. Three tumors (25%) showed nuclear accumulation of p53. Moderate and high proliferative activity was observed in four and eight of tumors, respectively. Eight patients presented with stage IB1 tumor (67%), 3 with stage IA1 tumor (25%), and 1 with stage IIIA tumor (8%). Eleven patients (92%) were alive as of last contact with a mean follow-up of 34.2 months (range: 5 days to 84 months). CONCLUSION In this series of patient, PSCC of the uterine cervix had a low rate of HPV DNA in their genome and a low rate of p53 gene abnormality. These genotypic differences may explain the differences between the clinical behavior of PSCC and the common types of squamous cell carcinomas of the cervix.
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Affiliation(s)
- Ramin Mirhashemi
- Harbor-UCLA Medical Center, David Geffen School of Medicine, Department of Obstetrics and Gynecology, Box 3, 1000 W. Carson St., Torrance, CA 90502, USA.
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Abstract
Squamous cell carcinoma is the most common malignant cervical tumor, but the incidence of adenocarcinomas has been rising during the past few decades. This article discusses the epidemiology and pathogenesis of the squamous cell carcinoma, its clinical and histologic features, including microinvasive carcinoma, its histologic grade, and variant tumors. The prognostic impact of these features and the differential diagnosis are also covered. The second portion of this article is devoted to the glandular tumors of the cervix, including adenocarcinoma in situ and invasive adenocarcinoma and its variants. The differential diagnosis of these tumors with tumor like glandular lesions is given special attention. Finally, less common malignant cervical tumors are covered, with an emphasis being placed on their significance.
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Affiliation(s)
- Steven G Silverberg
- Department of Anatomic Pathology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Fujimoto T, Sakuragi N, Shimizu M, Watari H, Takeda M, Okamoto K, Nomura E, Yamamoto R, Okuyama K, Fujimoto S. Papillary squamous cell carcinoma of the uterine cervix: a report of two cases with human papillomavirus 16 DNA. Acta Obstet Gynecol Scand 2002; 81:176-8. [PMID: 11942912 DOI: 10.1034/j.1600-0412.2002.810217.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Toshio Fujimoto
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan
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Brinck U, Jakob C, Bau O, Füzesi L. Papillary squamous cell carcinoma of the uterine cervix: report of three cases and a review of its classification. Int J Gynecol Pathol 2000; 19:231-5. [PMID: 10907171 DOI: 10.1097/00004347-200007000-00006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Papillary squamous cell carcinoma (SCC) of the uterine cervix has been defined as a malignant squamous cell lesion characterized by a papillary architecture with fibrovascular cores and moderate to severe dysplasia devoid of frank keratinization and koilocytic change. Papillary SCC should be histopathologically delineated from other rare variants of SCC with papillary features including verrucous and condylomatous carcinoma and the recently recognized (squamo-)transitional cell carcinoma of the uterine cervix. We report three cases of papillary SCC (FIGO stages IB, IV, and IVB) in postmenopausal women. Each tumor tested was positive for human papillomavirus (HPV) 16 and negative for HPV 6, 11 and 18 by general primer mediated polymerase chain reaction and subsequent enzyme-linked immunosorbent assay (PCR-ELISA). These findings 1) support the hypothesis that papillary SCCs (unlike verrucous carcinoma) are similar with regard to risk factors to (squamo-)transitional and condylomatous carcinoma; 2) suggest that HPV may play an etiologic role in at least some of these tumors; and 3) suggest that papillary SCC is the only subtype among squamous/(squamo-)transitional carcinomas that is associated with high-risk HPV infection in the absence of HPV-related histopathologic alterations.
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Affiliation(s)
- U Brinck
- Department of Pathology, Georg-August University, Göttingen, Germany
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Al-Nafussi AI, Monaghan H. Squamous carcinoma of the uterine cervix with CIN 3-like growth pattern: An under-diagnosed lesion. Int J Gynecol Cancer 2000; 10:95-99. [PMID: 11240659 DOI: 10.1046/j.1525-1438.2000.00017.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive squamous carcinomas of the cervix have traditionally been classified into keratinizing, non-keratinizing, verrucous, warty (condylomatous), papillary transitional (squamo-transitional), and lymphoepithelioma-like carcinomas. The majority of these tumors are easily recognized. We present for the first time the pathological appearances of six cases of invasive squamous carcinoma with growth pattern simulating tangentially cut CIN 3 involving endocervical glandular crypts/clefts. In all cases initial diagnosis on biopsy and/or loop excision was thought to be CIN 3, perhaps with suspicion of early invasion. On further excision and/or on clinical grounds the tumors were frankly invasive. We propose the use of the term squamous carcinoma with "CIN 3-like growth pattern" for such lesions. This is in order to avoid misinterpretation as CIN 3 with subsequent inappropriate management of patients with this type of tumor.
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Affiliation(s)
- A. I. Al-Nafussi
- Department of Pathology, University of Edinburgh, Edinburgh, Scotland United Kingdom
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Cho NH, Joo HJ, Ahn HJ, Jung WH, Lee KG. Detection of human papillomavirus in warty carcinoma of the uterine cervix: comparison of immunohistochemistry, in situ hybridization and in situ polymerase chain reaction methods. Pathol Res Pract 1998; 194:713-20. [PMID: 9820868 DOI: 10.1016/s0344-0338(98)80131-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Warty carcinoma of the uterine cervix is a very rare specific variant of invasive squamous cell carcinoma, usually described as a hybrid feature of condyloma with invasive squamous cell carcinoma. Besides having the koilocytes and maturation of squamous epithelium, there is unequivocal stromal invasion. The feathery surface seems to be characteristic of warty carcinoma, differentiating it from condylomata acuminata or verrucous carcinoma. Using in situ polymerase chain reaction (IS-PCR) and in situ hybridization (ISH) as well as an immunohistochemical technique (IHC), we determined the amplification and expression of several human papilloma virus (HPV) types (6, 11, 33, 16 and 18) in nine warty carcinomas of the uterine cervix. We found amplified HPV predominantly in the nuclei of the feathery surface in all cases only when IS-PCR was applied, while it was detected only in five (55.6%) or six cases (66.7%) by conventional IHC or ISH, respectively. We found multiple types in the same lesion in six cases (66.7%) by IS-PCR, in comparison with ISH which detected a lower incidence (22.2%). This finding of coinfection is more consistent with that seen in low-grade squamous intraepithelial lesions (LSILs) of the uterine cervix than in high SIL. It is important to be aware of these distinct lesions in postmenopausal women with their characteristic feathery and thin surface, as well as a hybrid form of exophytic condyloma and stromal invasion, and frequent coinfection of multiple different HPVs as a type of LSILs.
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Affiliation(s)
- N H Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Nakamura E, Shimizu M, Fujiwara K, Yamauchi H, Monobe Y, Hirokawa M, Kohno I, Manabe T. Papillary squamous cell carcinoma of the uterine cervix: diagnostic pitfalls. APMIS 1998; 106:975-8. [PMID: 9833700 DOI: 10.1111/j.1699-0463.1998.tb00248.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case of papillary squamous cell carcinoma (PSCC) of the uterine cervix is reported. The patient was a 73-year-old Japanese woman with acute renal failure and bilateral hydronephrosis. A cauliflower-like mass was found in the uterine cervix. A uterine cervical biopsy specimen revealed PSCC in situ, while clinically it was an invasive carcinoma. Uterine cervical biopsy was performed a second time to confirm its stromal invasion. However, only small fragments were obtained because of heavy bleeding from the tumor and they showed PSCC in situ again. Following this, computed tomography of the pelvis revealed a 5 cm mass in the uterine cervix, invading the vagina and urinary bladder. Though deep-wedge biopsy, loop electrosurgical excision, or cone biopsy is recommended to evaluate PSCC, it may be impossible to perform any of these procedures because of bleeding such as that seen in our case. In these circumstances, good communication between pathologists and clinicians is important since lack of communication may cause PSCC to be microscopically misinterpreted as in situ carcinoma rather than invasive carcinoma.
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Affiliation(s)
- E Nakamura
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
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Trivijitsilp P, Mosher R, Sheets EE, Sun D, Crum CP. Papillary immature metaplasia (immature condyloma) of the cervix: a clinicopathologic analysis and comparison with papillary squamous carcinoma. Hum Pathol 1998; 29:641-8. [PMID: 9635687 DOI: 10.1016/s0046-8177(98)80016-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Papillary immature metaplasia (PIM) is a variant of human papillomavirus (HPV) 6 or 11 infection. PIM resembles an immature metaplasia but has filiform papillae, variable cytological atypia, and, frequently, extension into the endocervical canal. Because the unusual morphology and presentation of PIM may cause confusion between this and other benign and malignant papillary neoplasms, we conducted a clinicopathologic analysis of PIM and compared expression of Ki-67 between PIM, condyloma, and papillary carcinoma. Data on patient age, duration of the lesions, and procedures, including cone biopsy, were obtained. The distribution and intensity of staining for Ki-67 in the epithelium was recorded and compared with both condyloma and papillary carcinoma. HPV typing was performed by polymerase chain reaction (PCR) and restriction fragment length pleomorphism analysis (RFLP). Ten of 13 PIMs were HPV 6/11 positive. Three cases contained areas closely resembling condyloma. Eleven cone biopsies were performed on nine cases. Three were found to have a coexisting high-grade squamous intraepithelial lesion that was either HPV 6/11 negative or contained another HPV type. All PIMs displayed variable staining for Ki-67 with a low index of staining in the mid and upper epithelial layers. In contrast, areas of condyloma had significantly stronger staining in areas with viral cytopathic effect (koilocytosis). Six papillary carcinomas were analyzed and displayed moderate to diffuse staining, including staining of the superficial cell nuclei. PIM is a distinct pathological subset of cervical condyloma that frequently is managed by cone biopsy and may persist. The marked reduction in Ki-67 staining in superficial cell layers distinguishes PIM from some condylomata and most HSILs and papillary carcinomas. Immunostaining thus may be helpful in distinguishing PIM from papillary carcinoma, although the differentiation of the two is best made on morphological grounds.
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Affiliation(s)
- P Trivijitsilp
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Abstract
A distinctive variant of a papillary noninvasive transitional cell carcinoma (TCC) of the vagina removed from a postmenopausal woman is described. The neoplasm was evaluated by immunohistochemistry. The designation of this neoplasm as a TCC is supported by its morphological features and its coexpression for cytokeratin (CK) 7 and CK 20. Its main feature is pagetoid infiltration into adjacent vaginal epithelium. This is the second reported case involving a transitional cell metaplasia (TCM) of the vagina, a possible precursor lesion of the TCC.
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Affiliation(s)
- G Singer
- Division of Surgical Pathology, Cantonal Hospital, Baden, Switzerland
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Cowper SE, Fiorica JV, Haller EM, Nicosia SV, Jones M, Coppola D. Papillary Squamous Cell Carcinoma. Cancer Control 1998; 5:179-1183. [PMID: 10761029 DOI: 10.1177/107327489800500211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This regular feature presents special issues in oncologic pathology.
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Affiliation(s)
- SE Cowper
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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Koenig C, Turnicky RP, Kankam CF, Tavassoli FA. Papillary squamotransitional cell carcinoma of the cervix: a report of 32 cases. Am J Surg Pathol 1997; 21:915-21. [PMID: 9255254 DOI: 10.1097/00000478-199708000-00005] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Papillary carcinomas of the uterine cervix with transitional or squamous differentiation are rare tumors that often resemble transitional cell carcinomas of the urinary tract. We reviewed 32 such cases of papillary cervical carcinoma and divided them into three groups: 1) predominantly (> 90%) squamous (nine cases), 2) mixed squamous and transitional (16 cases), and 3) predominantly transitional (seven cases). Overall, the patients ranged in age from 22 to 93 years (mean 50), and the most common clinical presentation was abnormal bleeding (15 patients) and an abnormal Papanicolaou smear (nine patients). The tumors ranged in size from 0.7 to 6.0 cm (mean 3.0). All cases demonstrated a papillary architecture with fibrovascular cores lined by a multilayered, atypical epithelium resembling a high-grade squamous intraepithelial lesion of the cervix. Underlying superficial to deep stromal invasion was seen in 18 of 20 cases (90%); in the remaining 12 cases, the specimen was too superficial to assess invasion. Eighteen (86%) of the 21 cases examined immunohistochemically demonstrated immunoreactivity for cytokeratin 7, whereas only two of the 21 (9.5%) showed positivity for cytokeratin 20. Of the 12 women for whom follow-up information was available, three were treated by simple hysterectomy, two underwent radical hysterectomy, one was treated with radiation alone, and one with combination chemotherapy and radiotherapy. Three patients died of disease (two in the squamous group and one transitional) within an average of 13 months after diagnosis. Local recurrence developed in two women, and one of these, a vaginal recurrence, occurred 12 years after the original diagnosis. Based on the above findings, we believe that these tumors are a clinicopathologically distinct, homogeneous group that display a morphologic spectrum. Nevertheless, because some tumors may show a purely squamous or purely transitional appearance, we propose retaining the above three separate designations for these tumors with the understanding that there is often a substantial degree of subjectivity in deciding whether a tumor is squamous or transitional. The most distinctive, objective, and easily recognizable feature of these tumors is their surface papillary architecture rather than their superficial resemblance to transitional cell carcinomas of the urinary tract, and we emphasize the need to distinguish these potentially aggressive malignant tumors from the far more common and benign papillary lesions of the cervix.
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Affiliation(s)
- C Koenig
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Affiliation(s)
- W D Lawrence
- Department of Anatomic Pathology, Wayne State University School of Medicine, Detroit, MI
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Fetissof F, Haillot O, Lanson Y, Arbeille B, Lansac J. Papillary tumour of the vagina resembling transitional cell carcinoma. Pathol Res Pract 1990; 186:358-64. [PMID: 2377571 DOI: 10.1016/s0344-0338(11)80294-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of a peculiar papillary neoplasia of the vagina resembling a urothelial tumour is presented. Four vaginal tumours were excised from a 76-year-old woman. Five years before this patient had undergone a uretero-nephrectomy for a non-invasive papillary transitional cell carcinoma of the renal pelvis. The four vaginal tumours demonstrated gross and microscopic similarities to low-grade papillary transitional cell carcinoma of the urinary tract. This observation indicates that multicentric, non-invasive, papillary tumours may affect the whole uro-genital area. The vaginal wall was not overlaid by a normal squamous epithelium, but by a peculiar "transitional-like" epithelium. Variegated endocrine cells were documented within this lining, using immunohistochemical and ultrastructural techniques. The eventuality of a histogenetic link between the tumour and the adjacent epithelial lining remains unresolved.
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MESH Headings
- Aged
- Bombesin/metabolism
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/metabolism
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/ultrastructure
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/ultrastructure
- Chromogranins/metabolism
- Diagnosis, Differential
- Female
- Humans
- Immunohistochemistry
- Microscopy, Electron
- Mucous Membrane/metabolism
- Mucous Membrane/pathology
- Mucous Membrane/ultrastructure
- Phosphopyruvate Hydratase/metabolism
- Serotonin/metabolism
- Vaginal Neoplasms/metabolism
- Vaginal Neoplasms/pathology
- Vaginal Neoplasms/ultrastructure
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Affiliation(s)
- F Fetissof
- Laboratoire d'Anatomie pathologique, Faculté de Médecine, Tours, France
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Randall ME, Constable WC, Hahn SS, Kim JA, Mills SE. Results of the radiotherapeutic management of carcinoma of the cervix with emphasis on the influence of histologic classification. Cancer 1988; 62:48-53. [PMID: 3133103 DOI: 10.1002/1097-0142(19880701)62:1<48::aid-cncr2820620111>3.0.co;2-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The histology of 365 of 396 patients (92%) treated with radiation therapy at the University of Virginia from 1968 to 1978 has been reviewed. Staging and treatment policies were consistent throughout this period, and have enabled the influence of histologic classification on treatment results to be evaluated. Large cell nonkeratinizing carcinoma (LCNK) was the most common type, 69%; followed by keratinizing (KSCC), 13%; and adenocarcinoma, 6.6%. Other varieties included adenosquamous, 3.6%; small cell undifferentiated carcinoma, 2.7%; papillary squamous, 1.6%; and glassy cell, 1.4%. Overall survivals by stage were similar to those reported from other centers. When examined by histologic type, the 5-year survival rates ranged from 64% for adenosquamous to 13% for small cell. The most common varieties, LCNK and KSCC, had survival rates of 61% and 40% (P = 0.008). Considering both stage and histologic type, the differences between LCNK and KSCC persisted and were significant for Stage IIB (P = 0.023). Of particular interest are the poor results in small cell carcinoma and adenocarcinoma, except in the earliest stages, and the good results for adenosquamous carcinoma. The patterns of failure by histologic type showed that local failures were higher in cases of KSCC than in LCNK, indicating a probable difference in radiosensitivity. Distant spread was similar for both types. Both small cell carcinoma and adenocarcinoma showed high rates of distant spread and local failure except in the early stages. Considering survival and failure rates, three prognostic groups could be identified. In descending order of curability these were: 1) LCNK and adenosquamous carcinoma; 2) KSCC, papillary squamous carcinoma, and adenocarcinoma; and 3) small cell carcinoma and glassy cell carcinoma.
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Affiliation(s)
- M E Randall
- Division of Therapeutic Radiology and Oncology, University of Virginia Medical Center, Charlottesville 22908
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Stuart GC, Robertson DI, Fedorkow DM, Duggan MA, Nation JG. Recurrent and persistent squamous cell cervical carcinoma in women under age 35. Gynecol Oncol 1988; 30:163-72. [PMID: 3371740 DOI: 10.1016/0090-8258(88)90020-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Forty-five patients with invasive cervical squamous cell carcinoma were registered in the Tom Baker Cancer Centre from 1980 to 1985. The natural history of 22 patients (48.9%) who developed persistent or recurrent disease including 11 Stage IB, 8 Stage IIB, and 3 Stage IIIB is reported. Only one patient who had the uncommon papillary variant is alive without evidence of residual disease. The remainder are either dead (16) or alive with residual disease (5). Four patients never achieved a disease-free status and in the remainder recurrences developed on average in 8.7 months. Central or regional disease was not controlled in 20 of 22 patients. Neither radical surgery nor radiotherapy was evidently more effective in preventing persistent or recurrent disease. A reliable predictive marker for persistent or recurrent disease is required: lymph-vascular invasion in the radical hysterectomy specimens was present in 5 of 6 cases but it is subject to interpretive error. Since the disease is frequently systemic at the time of diagnosis, early adjuvant therapy and improved staging techniques are required to improve the survival.
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Affiliation(s)
- G C Stuart
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada
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47
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Fedorkow DM, Robertson DI, Duggan MA, Nation JG, McGregor SE, Stuart GC. Invasive squamous cell carcinoma of the cervix in women less than 35 years old: recurrent versus nonrecurrent disease. Am J Obstet Gynecol 1988; 158:307-11. [PMID: 3341410 DOI: 10.1016/0002-9378(88)90144-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Invasive cervical squamous cell carcinoma was diagnosed in 45 patients less than 35 years old from 1980 to 1985. Thirty-two cases were Stage IB; 10, Stage IIB; and three, Stage IIIB. Twenty-two patients developed persistent or recurrent disease. Only one of these is now alive with no evidence of tumor. The mean interval from diagnosis to recurrence was 8.7 months (median of 7.0) and from diagnosis to death was 14.7 months (median of 12.0). Eleven of 32 patients with Stage IB disease developed a recurrence; the intervals to recurrence in Stage IB disease were similar to those for more advanced stages. Factors predicting recurrence included advanced stage of the disease and tumor bulk (maximum size, depth of invasion, and number of involved quadrants) as well as an exophytic or ulcerative tumor and a symptomatic presentation. These factors may identify the patient at high risk for recurrence who would benefit from adjuvant therapy.
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Affiliation(s)
- D M Fedorkow
- Department of Obstetrics and Gynecology, Tom Baker Cancer Centre, Foothills Hospital, Calgary, Alberta, Canada
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