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Gonzalez R, Saha A, Campbell CJ, Nejat P, Lokker C, Norgan AP. Seeing the random forest through the decision trees. Supporting learning health systems from histopathology with machine learning models: Challenges and opportunities. J Pathol Inform 2024; 15:100347. [PMID: 38162950 PMCID: PMC10755052 DOI: 10.1016/j.jpi.2023.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/06/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
This paper discusses some overlooked challenges faced when working with machine learning models for histopathology and presents a novel opportunity to support "Learning Health Systems" with them. Initially, the authors elaborate on these challenges after separating them according to their mitigation strategies: those that need innovative approaches, time, or future technological capabilities and those that require a conceptual reappraisal from a critical perspective. Then, a novel opportunity to support "Learning Health Systems" by integrating hidden information extracted by ML models from digitalized histopathology slides with other healthcare big data is presented.
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Affiliation(s)
- Ricardo Gonzalez
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
- Division of Computational Pathology and Artificial Intelligence, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Ashirbani Saha
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Escarpment Cancer Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Clinton J.V. Campbell
- William Osler Health System, Brampton, Ontario, Canada
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peyman Nejat
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P. Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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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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Kajabwangu R, Izudi J, Bazira J, Ssedyabane F, Turanzomwe S, Birungi A, Ngonzi J, Bajunirwe F, Randall TC. Effect of metabolic syndrome and its components on the risk and prognosis of cervical cancer: A literature review. Gynecol Oncol Rep 2024; 54:101438. [PMID: 39035032 PMCID: PMC11260376 DOI: 10.1016/j.gore.2024.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Despite the global implementation of preventive strategies against Human Papilloma Virus (HPV) infection, the incidence of invasive cervical cancer rose by nearly 1.3-fold, from 471,000 annual cases in 2000 to 604,000 cases in 2020. With over 340,000 deaths annually, cervical cancer is the fourth leading cause of cancer mortality in women globally. There is a need to understand other factors besides HPV such as metabolic syndrome (MetS) that potentially influence the onset and progression of cervical cancer. In this narrative review, we describe evidence showing that Metabolic syndrome (MetS) increases the risk for cervical cancer and worsens its prognosis. Combined screening for MetS and cervical cancer has potential to significantly reduce morbidity and mortality in women with cervical cancer.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
| | - Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
| | - Abraham Birungi
- Department of Pathology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara Uganda
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Tostrud LJ, Somasegar S, Renz M. Site-agnostic PARP-inhibitor maintenance therapy of advanced stage BRCA2-mutated gastric-type endocervical adenocarcinoma: A case report. Gynecol Oncol Rep 2024; 53:101406. [PMID: 38736717 PMCID: PMC11088272 DOI: 10.1016/j.gore.2024.101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
•Gastric-type endocervical adenocarcinomas (GEA) are rare, aggressive cancers with limited therapeutic options. •Although therapeutic effects of PARP-inhibitors in non-BRCA-associated cancers might be limited, clinical data is sparse. •Given limited treatment options and poor prognosis of GEA, somatic BRCA mutation testing, and PARP-inhibitor maintenance can be considered.
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Affiliation(s)
- Lauren Jill Tostrud
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sahana Somasegar
- Gynecologic Oncology Division, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Malte Renz
- Stanford University, Stanford, CA, United States
- Department of Obstetrics & Gynecology, Heinrich-Heine University Düsseldorf, Germany
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Chalif J, Kistenfeger Q, Fulton J, Morton M, DeVengencie I, Weldemichael W, Vazzano J, O'Malley DM, Chambers LM. Diagnosis and management of gastric-type endocervical adenocarcinoma: A case report and review of the literature. Gynecol Oncol 2024; 185:165-172. [PMID: 38428332 DOI: 10.1016/j.ygyno.2024.02.024] [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] [Received: 01/02/2024] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Gastric-type endocervical adenocarcinoma (GEA), a rare subtype of cervical cancer, has garnered increasing attention recently for its distinctive histopathological features, unique classification, genetic characteristics, and variable clinical outcomes compared to squamous cell and adenocarcinoma subtypes. Historically, GEA has evolved from a poorly understood entity to a distinct subtype of cervical adenocarcinoma, only recently recognized in the 2020 World Health Organization (WHO) classification. Accordingly, characteristic morphological features define GEA, shedding light on the diagnostic challenges and potential misclassification that can occur in clinical practice. Genetic alterations, including KRAS, ARID1A, and PIK3CA mutations, play a pivotal role in the development and progression of GEA. This article reviews a case of GEA and aims to provide a contemporary overview of the genetic mutations and molecular pathways implicated in GEA pathogenesis, highlighting potential therapeutic targets and the prospects of precision medicine in its management. Patients with GEA have variable clinical outcomes, with some exhibiting aggressive behavior while others follow a more indolent course. This review examines the factors contributing to this heterogeneity, including stage at diagnosis, histological grade, and genetic alterations, and their implications for patient prognoses. Treatment strategies for GEA remain a topic of debate and research. Here, we summarize the current therapeutic options, including surgery, radiation therapy, and chemotherapy, while also exploring emerging approaches, such as targeted therapies and immunotherapy. This article provides a comprehensive overview of GEA, synthesizing current knowledge from historical perspectives to contemporary insights, focusing on its classification, genetics, outcomes, and therapeutic strategies.
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Affiliation(s)
- Julia Chalif
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
| | - Quinn Kistenfeger
- Division of Obstetrics & Gynecology, The Ohio State University, Columbus, OH, USA
| | - Jessica Fulton
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Molly Morton
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | | | - Wegahta Weldemichael
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Vazzano
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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Kobayashi N, Oike T, Ando K, Murata K, Tamaki T, Noda SE, Kogure K, Nobusawa S, Oyama T, Ohno T. Carbon ion radiotherapy for mesonephric adenocarcinoma of the uterine cervix: a case report. J Med Case Rep 2024; 18:228. [PMID: 38720351 PMCID: PMC11080269 DOI: 10.1186/s13256-024-04548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mesonephric adenocarcinoma is an extremely rare subtype of uterine cervical cancer that is associated with a poor prognosis and for which a standardized treatment protocol has not been established. Carbon ion radiotherapy (CIRT) is an emerging radiotherapy modality that has been shown to have a favorable anti-tumor effect, even for tumors resistant to conventional photon radiotherapy or chemotherapy. However, there is no report on CIRT outcomes for mesonephric adenocarcinoma of the uterine cervix. CASE PRESENTATION We treated a 47-year-old Japanese woman with mesonephric adenocarcinoma of the uterine cervix (T2bN0M0 and stage IIB according to the 7th edition of the Union for International Cancer Control and International Federation of Gynecology and Obstetrics, respectively) with CIRT combined with brachytherapy and concurrent chemotherapy. CIRT consisted of whole pelvic irradiation and boost irradiation to the gross tumor; 36.0 Gy (relative biological effectiveness [RBE]) in 12 fractions and 19.2 Gy (RBE) in 4 fractions, respectively, performed once a day, four times per week. Computed tomography-based image-guided adaptive brachytherapy was performed after completion of CIRT, for which the D90 (i.e., the dose prescribed to 90% of the target volume) for the high-risk clinical target volume was 20.4 Gy in a total of 3 sessions in 2 weeks. A weekly cisplatin (40 mg/m2) dose was administered concomitantly with the radiotherapy for a total of five courses. From 4 months post-CIRT, the patient developed metastasis of the lung, with a total of 10 lung metastases over 70 months; these lesions were treated on each occasion by photon stereotactic body radiotherapy and/or systemic therapy. At 8 years from initial treatment (i.e., 2 years after the last treatment), the patient is alive without any evidence of recurrence and maintains a high quality of life. CONCLUSIONS This is the first report of CIRT for treatment of mesonephric adenocarcinoma of the uterine cervix. The present case indicates the potential efficacy of CIRT in combination with brachytherapy for treatment of this disease.
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Affiliation(s)
- Nao Kobayashi
- Department of Radiation Oncology, Kyorin University, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan.
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan.
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-Ku, Chiba-Shi, Chiba, 263-8555, Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima-Shi, Fukushima, 960-1295, Japan
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima-Shi, Fukushima, 960-1295, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-Shi, Saitama, 350-1298, Japan
| | - Kayoko Kogure
- Department of Obstetrics and Gynecology, Isesaki Municipal Hospital, 12-1 Tsunatorihonmachi, Isesaki-Shi, Gunma, 372-0817, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi-Shi, Gunma, 371-8511, Japan
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Nishio H, Matsuda R, Iwata T, Yamagami W. Gastric-type adenocarcinoma of the uterine cervix: clinical features and future directions. Jpn J Clin Oncol 2024; 54:516-520. [PMID: 38366663 PMCID: PMC11075765 DOI: 10.1093/jjco/hyae019] [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: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
The concept of gastric-type mucinous carcinoma of the uterine cervix (GAS) has been accepted worldwide because of its aggressive clinical behaviour and the absence of high-risk human papilloma virus infection. The World Health Organization (WHO) 2020 classification divides cervical tumours into two categories: human papilloma virus-associated and human papilloma virus-independent. Hence, GAS is now classified as an human papilloma virus-independent gastric type. Because clinical studies have reported that GAS is refractory to conventional treatments such as chemotherapy and radiotherapy, especially at an advanced stage, and has aggressive features with widespread dissemination to unusual sites, such as the omentum, peritoneum and distant organs, it is urgent to establish new treatment strategies by comparing the molecular profiles of human papilloma virus-associated adenocarcinomas. A series of genetic mutations characteristic to GAS encourage the development of future treatment strategies such as targeted therapy and immunotherapy.
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Affiliation(s)
- Hiroshi Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Risa Matsuda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Liu Q, Zhang X, Jiang X, Zhang C, Li J, Zhang X, Yang J, Yu N, Zhu Y, Liu J, Xie F, Li Y, Hao Y, Feng Y, Wang Q, Gao Q, Zhang W, Zhang T, Dong T, Cui B. A Histopathologic Image Analysis for the Classification of Endocervical Adenocarcinoma Silva Patterns Depend on Weakly Supervised Deep Learning. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:735-746. [PMID: 38382842 DOI: 10.1016/j.ajpath.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
Twenty-five percent of cervical cancers are classified as endocervical adenocarcinomas (EACs), which comprise a highly heterogeneous group of tumors. A histopathologic risk stratification system known as the Silva pattern system was developed based on morphology. However, accurately classifying such patterns can be challenging. The study objective was to develop a deep learning pipeline (Silva3-AI) that automatically analyzes whole slide image-based histopathologic images and identifies Silva patterns with high accuracy. Initially, a total of 202 patients with EACs and histopathologic slides were obtained from Qilu Hospital of Shandong University for developing and internally testing the Silva3-AI model. Subsequently, an additional 161 patients and slides were collected from seven other medical centers for independent testing. The Silva3-AI model was developed using a vision transformer and recurrent neural network architecture, utilizing multi-magnification patches, and its performance was evaluated based on a class-specific area under the receiver-operating characteristic curve. Silva3-AI achieved a class-specific area under the receiver-operating characteristic curve of 0.947 for Silva A, 0.908 for Silva B, and 0.947 for Silva C on the independent test set. Notably, the performance of Silva3-AI was consistent with that of professional pathologists with 10 years' diagnostic experience. Furthermore, the visualization of prediction heatmaps facilitated the identification of tumor microenvironment heterogeneity, which is known to contribute to variations in Silva patterns.
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Affiliation(s)
- Qingqing Liu
- Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Xiaofang Zhang
- Department of Pathology, School of Basic Medical Sciences and Qilu Hospital, Shandong University, Jinan City, China
| | - Xuji Jiang
- Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Chunyan Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical University of Shandong, Jining City, China
| | - Jiamei Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, China
| | - Xuedong Zhang
- Department of Pathology, Liaocheng People's Hospital, Liaocheng City, China
| | - Jingyan Yang
- Department of Pathology, The Second Hospital of Shandong University, Jinan City, China
| | - Ning Yu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou City, China
| | - Yongcun Zhu
- Department of Pathology, Weihai Municipal Hospital of Shandong University, Weihai City, China
| | - Jing Liu
- Department of Pathology, Jining No. 1 People's Hospital, Jining City, China
| | - Fengxiang Xie
- Department of Pathology, KingMed Diagnostics, Jinan City, China
| | - Yawen Li
- Department of Pathology, School of Basic Medical Sciences and Qilu Hospital, Shandong University, Jinan City, China
| | - Yiping Hao
- Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Yuan Feng
- Cheeloo College of Medicine, Shandong University, Jinan City, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan City, China
| | - Qun Gao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Wenjing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan City, China
| | - Teng Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan City, China
| | - Taotao Dong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan City, China.
| | - Baoxia Cui
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan City, China.
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9
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Liu S, Li F, Cao Q, Li N, Gao Q. A Case Study of Gastric Adenocarcinoma and Squamous Cell Carcinoma of the Cervix. Onco Targets Ther 2024; 17:339-344. [PMID: 38644954 PMCID: PMC11027916 DOI: 10.2147/ott.s435811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/28/2024] [Indexed: 04/23/2024] Open
Abstract
Gastric adenocarcinoma (GAS) is a rare subtype of mucinous adenocarcinoma characterized by gastric differentiation and is unrelated to human papillomavirus (HPV) infection. This report discusses a 40-year-old female who presented with abdominal distension accompanied by increased abdominal circumference. CT of the abdomen and pelvis showed a large 21.0*12.7*26.0 cm mass later diagnosed as GAS combined with squamous cell carcinoma on surgical pathology. Immunohistological staining of GAS was positive for CK7, MUC6, PAX-8 CEA, and P53 (wild type) and negative for CDX2, CK20, ER, PR, P16, and WT1. The proliferative index (Ki-67) was 20%. Immunohistochemical staining of squamous cell carcinoma was positive for P16 and P53 (wild type), and the proliferative index (Ki-67) was 90%. However, the pathogenesis and molecular mechanisms of GAS have not been fully elucidated. As more cases are identified and reported, additional targeted therapies can be developed and tested in these patients.
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Affiliation(s)
- Suqing Liu
- Department of Gynaecology and Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, People’s Republic of China
| | - Fengling Li
- Department of Gynaecology and Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, People’s Republic of China
| | - Qinghua Cao
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, People’s Republic of China
| | - Ning Li
- Department of Gynaecology and Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, People’s Republic of China
| | - Qian Gao
- Department of Gynaecology and Obstetrics, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, People’s Republic of China
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10
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Zhou J, Zhang X, Mao W, Zhu Y, Yan L, Jiang J, Zhang M. Pathological features of gastric‑type endocervical adenocarcinoma: A report of two cases. Oncol Lett 2024; 27:149. [PMID: 38406594 PMCID: PMC10884787 DOI: 10.3892/ol.2024.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Gastric-type endocervical adenocarcinoma (GEA) is an uncommon form of uterine cervical adenocarcinoma with an unfavorable prognosis. The tumor consists of glands exhibiting a morphological resemblance to gastric cells and occasionally manifests features akin to pancreaticobiliary mucinous adenocarcinoma. GEA differs from the typical cervical cancer, particularly in its lack of association with the human papillomavirus. Immunophenotypic analysis suggests intestinal differentiation. The present study reports two cases of GEA occurring in postmenopausal individuals who were diagnosed in Lishui Central Hospital (Lishui, China) between January 2015 and January 2023. Microscopic examination revealed cysts lined with mucinous cells within the tumors. Immunohistochemical assays confirmed the positivity of the tumors for cytokeratin 7, mucin (MUC)5AC, and mutant tumor protein p53, while the results were negative for tumor suppressor p16, and in one case for paired box protein 8, consistent with characteristics of mucinous adenocarcinoma originating from the gastrointestinal tract. Programmed death-ligand 1 expression was also negative. The proto-oncogene K-ras was identified using amplification refractory mutation system polymerase chain reaction. Both cases were negative for mutations in codons 12 and 13 of exon 2, codon 61 of exon 3 and codon 146 of exon 4, but were positive for wild-type K-ras. Clinical follow-up revealed a potential association between histopathological features and resistance to chemotherapeutic drugs. The infrequency of this tumor type may contribute to diagnostic challenges.
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Affiliation(s)
- Jiahui Zhou
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Xiangning Zhang
- Department of Pathophysiology, School of Basic Medicine, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
- China-America Cancer Research Institute, Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Weibo Mao
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Yiling Zhu
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Liping Yan
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Jiangle Jiang
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Min Zhang
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
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Cao D, Yang Z, Dong S, Li Y, Mao Z, Lu Q, Xu P, Shao M, Pan L, Han X, Yuan J, Fan Q, Chen L, Wang Y, Zhu W, Yu W, Wang Y. PCDHGB7 hypermethylation-based Cervical cancer Methylation (CerMe) detection for the triage of high-risk human papillomavirus-positive women: a prospective cohort study. BMC Med 2024; 22:55. [PMID: 38317152 PMCID: PMC10845746 DOI: 10.1186/s12916-024-03267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Implementation of high-risk human papillomavirus (hrHPV) screening has greatly reduced the incidence and mortality of cervical cancer. However, a triage strategy that is effective, noninvasive, and independent from the subjective interpretation of pathologists is urgently required to decrease unnecessary colposcopy referrals in hrHPV-positive women. METHODS A total of 3251 hrHPV-positive women aged 30-82 years (median = 41 years) from International Peace Maternity and Child Health Hospital were included in the training set (n = 2116) and the validation set (n = 1135) to establish Cervical cancer Methylation (CerMe) detection. The performance of CerMe as a triage for hrHPV-positive women was evaluated. RESULTS CerMe detection efficiently distinguished cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) from cervical intraepithelial neoplasia grade 1 or normal (CIN1 -) women with excellent sensitivity of 82.4% (95% CI = 72.6 ~ 89.8%) and specificity of 91.1% (95% CI = 89.2 ~ 92.7%). Importantly, CerMe showed improved specificity (92.1% vs. 74.9%) in other 12 hrHPV type-positive women as well as superior sensitivity (80.8% vs. 61.5%) and specificity (88.9% vs. 75.3%) in HPV16/18 type-positive women compared with cytology testing. CerMe performed well in the triage of hrHPV-positive women with ASC-US (sensitivity = 74.4%, specificity = 87.5%) or LSIL cytology (sensitivity = 84.4%, specificity = 83.9%). CONCLUSIONS PCDHGB7 hypermethylation-based CerMe detection can be used as a triage strategy for hrHPV-positive women to reduce unnecessary over-referrals. TRIAL REGISTRATION ChiCTR2100048972. Registered on 19 July 2021.
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Affiliation(s)
- Dan Cao
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhicong Yang
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihua Dong
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Li
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhanrui Mao
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Lu
- Department of Obstetrics and Gynecology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Peng Xu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minfang Shao
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Pan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xu Han
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qiong Fan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Lei Chen
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yanzhong Wang
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wenqiang Yu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yudong Wang
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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12
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Gradissimo A, Clarke MA, Xue X, Castle PE, Raine-Bennett TR, Schiffman M, Wentzensen N, Strickler HD, Burk RD. A novel human papillomavirus and host DNA methylation score and detection of cervical adenocarcinoma. J Natl Cancer Inst 2023; 115:1535-1543. [PMID: 37467068 PMCID: PMC10699843 DOI: 10.1093/jnci/djad134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The widespread introduction of Pap testing in the 1960s was followed by substantial reductions in the incidence of cervical squamous cell cancer (SCC). However, the incidence of cervical adenocarcinoma (ADC) did not decrease, likely because of low Pap test sensitivity for ADC and adenocarcinoma in situ (AIS). This study assessed a novel human papillomavirus (HPV) and host DNA Methylation Score for AIS and ADC screening. METHODS We measured methylation levels at CpG sites in the L2/L1 open reading frames of HPV16, HPV18, and HPV45-as well as 2 human loci, DCC and HS3ST2. Specifically, we tested exfoliated cervicovaginal cells from women in the HPV Persistence and Progression (PaP) cohort who were positive for 1 of HPV16, 18, or 45, including: 1) 176 with AIS/ADC, 2) 353 with cervical intraepithelial neoplasia-3 (CIN3) or SCC, and 3) controls who either cleared (HPV-Clearers; n = 579) or had persistent HPV16, 18, or 45 infection (HPV-Persisters; n = 292). CpG site-specific methylation percentages were measured using our reported next-generation methods. The Methylation Score was the average methylation percentage across all 35 CpG sites tested. RESULTS Each individual CpG site had higher methylation percentages in exfoliated cervicovaginal cells collected from patients with AIS/ADC, and as well as those with CIN3/SCC, relative to either control group (weakest P = .004). The Methylation Score for AIS/ADC had a sensitivity of 74% and specificity of 89%. The multivariate odds ratio (OR) between the Methylation Score (4th vs 1st quartile) for AIS/ADC was ORq4-q1 = 49.01 (PBenjamini-Hochberg = 4.64E-12), using HPV-Clearers as controls. CIN3/SCC had similar, albeit weaker, associations with the Methylation Score. CONCLUSIONS HPV16/18/45-infected women with Methylation Scores in the highest quartile had very high odds of AIS/ADC, suggesting they may warrant careful histologic evaluation of the cervical transition zone (eg, conization or loop electrosurgical excision procedure [LEEP]).
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Affiliation(s)
- Ana Gradissimo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Immunology, Memorial Sloan Kettering Cancer Center, Manhattan, NY, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Howard D Strickler
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert D Burk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Departments of Microbiology & Immunology, Gynecology & Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Yin Z, Cui Z, Kang S, Ji M, Li D, Chen B, Zhan X, Li W, Liu P, Chen C. Laparoscopic versus open radical hysterectomy in FIGO 2018 early-stage cervical adenocarcinoma: Long-term survival outcomes after propensity score matching. J Obstet Gynaecol Res 2023; 49:2849-2859. [PMID: 37658744 DOI: 10.1111/jog.15785] [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] [Received: 05/03/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare the long-term survival outcomes of laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in International Federation of Gynecology and Obstetrics (FIGO) 2018 early-stage cervical adenocarcinoma. METHODS Based on the clinical diagnosis and treatment for cervical cancer in mainland China (Four C) database, the medical records of 1098 patients with FIGO 2018 early-stage cervical adenocarcinoma were retrospectively reviewed. Long-term and short-term survival outcomes of the two groups were compared using a multivariate Cox regression model and the log-rank method in the whole study population and after propensity score matching. RESULTS There was no difference in disease-free survival (hazard ratio [HR] 0.921, 95% confidence interval [CI]: 0.532-1.595, p = 0.770) and overall survival (HR 1.168, 95% CI: 0.526-2.592, p = 0.702) between LRH (n = 468) and ORH (n = 468) in the risk-adjusted analysis. LRH resulted in significantly lower estimated blood loss (342.7 vs. 157.5 mL, p < 0.001) and shorter postoperative anal exhaust time (2.8 vs. 2.5 days, p < 0.001) in risk-adjusted analysis. The overall rates of intraoperative complications (2.4% vs. 4.3%, p = 0.100) and postoperative complications (7.5% vs. 6.2%, p = 0.437) showed no significant difference between the two groups. However, the LRH group had a significantly higher incidence of ureter injury (0.4% vs. 2.4%, p = 0.012) and great vessel injury (0.0% vs. 0.9%, p = 0.045) compared to the other group. No statistical variation in the site of recurrence was observed between the two groups (p = 0.613). CONCLUSIONS LRH has comparable survival outcomes with ORH and was associated with earlier recovery in FIGO 2018 early-stage adenocarcinoma of the uterine cervix. However, the LRH group had higher risk of ureter injury and great vessel injury.
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Affiliation(s)
- Zhaohong Yin
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhumei Cui
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shan Kang
- Department of Gynecology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Donglin Li
- Department of Obstetrics and Gynecology, Guizhou People's Hospital, Guiyang, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Xuemei Zhan
- Department of Obstetrics and Gynecology, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Zhang Z, Li Y, Wu Y, Bi R, Wu X, Ke G, Zhu J. Identifying tumor markers-stratified subtypes (CA-125/CA19-9/carcinoembryonic antigen) in cervical adenocarcinoma. Int J Biol Markers 2023; 38:223-232. [PMID: 37933442 DOI: 10.1177/03936155231206839] [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] [Indexed: 11/08/2023]
Abstract
OBJECTIVE There is a lack of research evaluating the effect of tumor markers for prognosis in cervical adenocarcinoma. We aimed to develop and validate a preoperative tumor-marker-based model including clinicopathological factors to clarify the prognostic value of endocervical adenocarcinoma. METHODS A total of 572 patients with cervical adenocarcinoma who were staged at the International Federation of Gynecology and Obstetrics (FIGO) IA-IIA were reviewed retrospectively. Preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA)-125 and CA19-9 levels were measured. The survival and recurrence patterns were analyzed according to the tumor-marker-related stratification. The predictive values of biomarkers and clinical variables were assessed with Cox regression and competing risk models. RESULTS Patients with elevated preoperative tumor markers had evidently poor overall survival and recurrence-free survival. The triple-elevated tumor marker (TETM) subgroup had the worst overall survival and progression-free survival than the triple-negative tumor marker (TNTM) subgroup and the single-elevated tumor marker (SETM) subgroup. The most important predictors for overall survival were elevated tumor markers, FIGO-stage, tumor differentiation, lymphovascular space invasion (LVSI) and lymph nodes metastasis. The most important predictors for recurrence-free survival were elevated tumor markers, FIGO-stage, tumor differentiation, LVSI and deep stromal invasion. Stratified analysis showed that elevated CA-125 and CA19-9 were significantly associated with postoperative distant metastasis. A decision curve analysis confirmed that a combination of tumor markers as predictors significantly outperformed the other common predictors used (FIGO-stage, intermediate and high-risk factors, tumor differentiation, lymph nodes). CONCLUSIONS Elevated preoperative serum CEA, CA-125, and CA19-9 levels exhibited poor overall survival and recurrence-free survival in cervical adenocarcinoma patients. Combined preoperative serum CA-125 and CA19-9 independently predicted distant metastasis in patients with endocervical adenocarcinoma.
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Affiliation(s)
- Zongkai Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Fujian Province, China
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yin Li
- Department of Otolaryngology, The First People's Hospital of Foshan, Foshan, China
| | - Ying Wu
- Department of Medical Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guihao Ke
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Zhu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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15
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Bae H, Kim HS. Endocervical Adenocarcinoma Showing Microcystic, Elongated, and Fragmented (MELF) Pattern of Stromal Invasion: A Single-Institutional Analysis of 10 Cases with Comprehensive Clinicopathological Analyses and Ki-67 Immunostaining. Biomedicines 2023; 11:3026. [PMID: 38002025 PMCID: PMC10669505 DOI: 10.3390/biomedicines11113026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Microcystic, elongated, and fragmented (MELF) pattern of invasion has seldom been documented in endocervical adenocarcinoma (EAC). The aim of this study was to analyze the clinicopathological characteristics of EAC showing MELF pattern. We collected the clinicopathological information of 10 cases of EAC with the MELF pattern and conducted polymer-based immunostaining for Ki-67 (dilution 1:200, clone MIB-1) on these cases. Ki-67 expression was assessed using the average estimation within the hotspot method. All tumors were human papillomavirus-associated EAC with Silva pattern C. All except one tumor exceeded 3 cm in size. Five tumors involved the entire thickness of the cervical stroma, and four tumors extended into the parametrium. Lymphovascular space invasion was identified in six cases. Two patients developed metastatic recurrences in the para-aortic lymph nodes and lungs, respectively. The MELF area showed significantly lower Ki-67 labelling index than that of a conventional tumor area. We confirmed our previous observation that the MELF area displayed lower proliferative activity than the conventional tumor area of EAC. We also demonstrated that patients with EAC showing MELF pattern had several adverse clinicopathological characteristics reflecting aggressive behavior. On the other hand, since the frequencies of post-operative recurrence and disease-related mortality that occurred during the follow-up period were relatively low, further investigations are warranted to clarify the prognostic value of MELF pattern in EAC patients.
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Affiliation(s)
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Parkash V, Aisagbonhi O, Riddle N, Siddon A, Panse G, Fadare O. Recent Advances in the Classification of Gynecological Tract Tumors: Updates From the 5th Edition of the World Health Organization "Blue Book". Arch Pathol Lab Med 2023; 147:1204-1216. [PMID: 36596270 DOI: 10.5858/arpa.2022-0166-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT.— The World Health Organization Classification of Tumours: Female Genital Tract Tumors, 5th edition, published in September 2020, comes 6 years after the 4th edition, and reflects the monumental leaps made in knowledge about the biology of gynecological tumors. Major changes include revised criteria for the assignment of the site of origin of ovarian and fallopian tube tumors, a revision in the classification of squamous and glandular lesions of the lower genital tract based on human papillomavirus association, and an entire chapter devoted to genetic tumor syndromes. This article highlights the changes in the 5th edition relative to the 4th edition, with a focus on areas of value to routine clinical practice. OBJECTIVE.— To provide a comprehensive update on the World Health Organization classification of gynecological tumors, highlighting in particular updated diagnostic criteria and terminology. DATA SOURCES.— The 4th and 5th editions of the World Health Organization Classification of Tumours. CONCLUSIONS.— The World Health Organization has made several changes in the 5th edition of the update on female genital tumors. Awareness of the changes is needed for pathologists' translation into contemporary practice.
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Affiliation(s)
- Vinita Parkash
- From the Department of Pathology (Parkash, Siddon, Panse), Yale University School of Medicine, New Haven, Connecticut
| | - Omonigho Aisagbonhi
- Department of Pathology, University of California at San Diego, La Jolla, California (Aisagbonhi, Fadare)
| | - Nicole Riddle
- The Department of Pathology and Cell Biology, Ruffolo, Hooper, and Associates, University of South Florida College of Medicine, Tampa, Florida (Riddle, Siddon)
| | - Alexa Siddon
- From the Department of Pathology (Parkash, Siddon, Panse), Yale University School of Medicine, New Haven, Connecticut
- Department of Laboratory Medicine (Siddon), Yale University School of Medicine, New Haven, Connecticut
- The Department of Pathology and Cell Biology, Ruffolo, Hooper, and Associates, University of South Florida College of Medicine, Tampa, Florida (Riddle, Siddon)
| | - Gauri Panse
- From the Department of Pathology (Parkash, Siddon, Panse), Yale University School of Medicine, New Haven, Connecticut
- The Department of Dermatology (Panse), Yale University School of Medicine, New Haven, Connecticut
| | - Oluwole Fadare
- Department of Pathology, University of California at San Diego, La Jolla, California (Aisagbonhi, Fadare)
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Zhang C, Li X, Zhong L, Wang Y, Yin J, Dai Y, Chen S, Liu Y, Sun L, Zhang X, Chen W. Assessment of the relationships between invasive endocervical adenocarcinoma and human papillomavirus infection and distribution characteristics in China: According to the new WHO classification criteria in 2020. Cancer Epidemiol 2023; 86:102442. [PMID: 37598648 DOI: 10.1016/j.canep.2023.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To assess the association between endocervical adenocarcinoma (ECA) and HPV (Human papillomavirus) infection, as well as the characteristics of ECA distribution in China. METHODS A total of 756 specimens were collected from seven geographic regions across China. All cases were histologically categorized according to the 2020 WHO classification of female genital tract cancers, and 496 cases were included. We performed the SPF10-DEIA-LiPA25 assay on all specimens' whole tissue sections using PCR (WTS-PCR) to detect HPV DNA and 141 WTS-PCR HPV-positive specimens were selected for the laser capture microdissection (LCM). RESULTS Four predominant prevalent histological categories of ECA in China were usual type (51.8%, 257), invasive stratified mucin-producing carcinoma (iSMILE) (11.5%, 57), mucinous NOS (not otherwise specid) (10.3%, 51), and gastric type (7.9%, 39). HPV positivity was 91.4% (235/257), 100.0% (57/57), and 90.2% (46/51) in usual type, iSMILE, and mucinous NOS by WTS-PCR detection, respectively (P < 0.001). LCM-PCR results showed a decreasing trend in HPV DNA positivity, and 21 (95.5%) patients with HPV-I were negative for HPV-DNA in glandular epithelial tissue. The most prevalent HPV genotypes in ECA were HPV16 (47.5%), 18 (40.8%), and 52 (6.5%). The average age of patients with HPVA was 44.9 years, while that of patients with HPV-I was 49.1 years, HPVA is more prevalent in younger females in China (P < 0.001). CONCLUSIONS In China, the predominant prevalent histological category of ECA is the usual type of adenocarcinoma, followed by iSMILE. Additionally, patients with HPVA tended to be younger than those with HPV-I.
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Affiliation(s)
- Changning Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China; College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071000, China
| | - Xinyue Li
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071000, China
| | - Li Zhong
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding 071000, China; Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA 91766, USA
| | - Yakun Wang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Jian Yin
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Yu Dai
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Simiao Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Yanna Liu
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Li Sun
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Xun Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.
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Bartin R, Delangle R, Mergui JL, Azaïs H, Bolze PA, Philip CA, Kerbage Y, Raimond E, Lecointre L, Carcopino X, Castela M, Uzan C, Canlorbe G. Impact of cervical excisional dimensions on endocervical margins status in adenocarcinoma in situ of the uterine cervix: A multicenter study from the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2023; 52:102622. [PMID: 37321399 DOI: 10.1016/j.jogoh.2023.102622] [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: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Excisional procedures have a central role in the management of adenocarcinoma in situ of the cervix (AIS). We aimed to evaluate the relationship between the excisional specimen dimensions and the endocervical margin status. METHODS We conducted a multicentric retrospective study in seven French centers. All cases with proven AIS on a colposcopic biopsy and undergoing an excisional procedure afterwards were included in the analysis. We evaluated the impact of excision length, along with the lateral and anteroposterior diameters on the endocervical margin status. An additional subgroup analysis of the impact of maternal age on endocervical margin status was also conducted. RESULTS Of the 101 cases of AIS diagnosed on initial biopsy, 95 underwent a primary excisional procedure, among which 80% (n = 76/95) had uninvolved endocervical margins and 20% (n = 19/95) had positive endocervical margins. The excisional specimen length was not significantly related to the endocervical margin status. Conversely, both lateral and antero-posterior diameters were significantly correlated with the negative endocervical margins status: OR = 1,19, 95% CI [1.03, 1.40], p = 0.025, for the lateral diameter and OR = 1.34, 95% CI [1.14, 1.64], p = 0.001 for the antero-posterior diameter. The median lateral diameter was 20 mm, IQR (18, 24) in case of endocervical negative margins vs. 18 mm IQR (15, 24) in case of positive endocervical margins (p = 0.039), and the median anteroposterior diameter was 17 mm IQR (15, 20) in case of negative endocervical margins vs 14 mm IQR (11, 15) in case of positive endocervical margins (p = 0.004), respectively. Additionally, in patients over 45 years old, endocervical margin were more likely to be positive despite similar excisional dimensions (7/17 (41%) of positive endocercival margins before 45 years old vs 12/78 (15%) after, p = 0.039) CONCLUSIONS: Endocervical margin statues were significantly related to the transverse diameters (lateral and anteroposterior diameters), but not to the excision specimen length. Reducing the excised length may lead to fewer post-procedure complications but would still allow to obtain a large proportion of negative endocervical margins.
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Affiliation(s)
- Raphael Bartin
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Romain Delangle
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Jean-Luc Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Charles-Andre Philip
- Department of Gynecologic and Oncologic Surgery and Obstetrics, CHU Lyon Croix-Rousse, Université Lyon 1, France
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Lise Lecointre
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mathieu Castela
- Scarcell Therapeutics, 101 rue de Sèvres, 75006 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France.
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19
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Peng H, Liu W, Jiang J, Du H. Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design. BMC Womens Health 2023; 23:454. [PMID: 37641051 PMCID: PMC10464471 DOI: 10.1186/s12905-023-02568-w] [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: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. METHODS This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. RESULTS Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3-4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. CONCLUSIONS Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Wencan Liu
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang City, 050051, Hebei, China.
| | - Hui Du
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China.
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20
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Su Y, Zhang Y, Zhou M, Zhang R, Chen S, Zhang L, Wang H, Zhang D, Zhang T, Li X, Zhang C, Wang B, Yuan S, Zhang M, Zhou Y, Cao L, Zhang M, Luo J. Genetic alterations in juvenile cervical clear cell adenocarcinoma unrelated to human papillomavirus. Front Med (Lausanne) 2023; 10:1211888. [PMID: 37654657 PMCID: PMC10466801 DOI: 10.3389/fmed.2023.1211888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
Clear cell adenocarcinoma of the cervix (CCAC) is a special type of HPV-independent cervical cancer. It has a low incidence rate, can be difficult to diagnose early, has a poor prognosis. Its peak incidence is in adolescence, which poses a great threat to women's health. Therefore, it is very important to explore the pathogenesis of cervical clear cell adenocarcinoma to guide subsequent treatment and prevention. This study analyzed 3 juvenile patients with CCAC diagnosed at the First Affiliated Hospital of Zhengzhou University. Using next-generation sequencing methods, we analyzed the pathogenesis of the patients and their close relatives by analyzing the genetic alterations of patients. CMTM5 was identified as the only shared mutated gene. Using published literature and comparative analyses of related disease-causing genes, 6 of the 19 genes (ALKBH7, MYCBP, MZF1, RNF207, RRS1, and TUSC2) were screened as genes with mutations in patients and had higher mutation rates in reproductive cancers. Pathway analysis showed that downregulated genes in non-HPV cervical cancer were mainly related to the immune system response, suggesting that non-HPV cervical cancer differs from HPV-infected cervical cancer in that the immune response is weaker, which is consistent with the weak correlation with viral infection.
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Affiliation(s)
- Yuehui Su
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Zhang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Mengjiao Zhou
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijin Zhang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Siang Chen
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Lili Zhang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Hao Wang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Dongdong Zhang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Ting Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinqiang Li
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingjie Wang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyu Yuan
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhuo Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhen Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjun Luo
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Epigenetic Regulation and Intervention, Chinese Academy of Sciences, Beijing, China
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21
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Sharma AE, Hodgson AJ, Howitt BE, Olkhov-Mitsel E, Djordjevic B, Park KJ, Nucci MR, Parra-Herran C. Molecular correlates of invasion pattern in HPV-associated endocervical adenocarcinoma: emergence of two distinct risk-stratified tiers. Histopathology 2023; 82:1067-1078. [PMID: 36849702 PMCID: PMC10263975 DOI: 10.1111/his.14893] [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] [Received: 01/23/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The pattern-based (Silva) classification of invasive human papilloma virus (HPV)-associated endocervical adenocarcinomas (HPVA) is an established and reproducible method to predict outcomes for this otherwise stage-dependent group of tumours. Previous studies utilising targeted sequencing have shown a correlation between mutational profiles and an invasive pattern. However, such correlation has not been explored using comprehensive molecular testing. DESIGN Clinicopathologic data including invasive pattern (Silva groups A, B, and C) was collected for a cohort of invasive HPVA, which previously underwent massive parallel sequencing using a panel covering 447 genes. Pathogenic alterations, molecular signatures, tumour mutational burden (TMB), and copy number alterations (CNA) were correlated with pattern of invasion. RESULTS Forty five HPVA (11 pattern A, 17 pattern B, and 17 pattern C tumours) were included. Patients with pattern A presented at stage I with no involved lymph nodes or evidence of recurrence (in those with >2 months of follow-up). Patterns B and C patients also mostly presented at stage I with negative lymph nodes, but had a greater frequency of recurrence; 3/17 pattern B and 1/17 pattern C HPVAs harboured lymphovascular space invasion (LVI). An APOBEC mutational signature was detected only in Silva pattern C tumours (5/17), and pathogenic PIK3CA changes were detected only in destructively invasive HPVA (patterns B and C). When cases were grouped as low-risk (pattern A and pattern B without LVI) and high-risk (pattern B with LVI and pattern C), high-risk tumours were enriched in mutations in PIK3CA, ATRX, and ERBB2. There was a statistically significant difference in TMB between low-risk and high-risk pattern tumours (P = 0.006), as well as between Pattern C tumours with and without an APOBEC signature (P = 0.002). CNA burden increased from pattern A to C. CONCLUSION Our findings further indicate that key molecular events in HPVA correlate with the morphologic invasive properties of the tumour and their aggressiveness. Pattern B tumours with LVI clustered with pattern C tumours, whereas pattern B tumours without LVI approached pattern A genotypically. Our study provides a biologic foundation for consolidating the Silva system into low-risk (pattern A + B without LVI) and high-risk (pattern B with LVI and pattern C) categories.
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Affiliation(s)
- Aarti E Sharma
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Anjelica J Hodgson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Brooke E Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Ekaterina Olkhov-Mitsel
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences, Centre, Toronto, ON, Canada
| | - 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
| | - Kay J Park
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marisa R Nucci
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
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22
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Giannella L, Delli Carpini G, Di Giuseppe J, Bogani G, Sopracordevole F, Clemente N, Giorda G, De Vincenzo RP, Evangelista MT, Gardella B, Dominoni M, Monti E, Alessi C, Alessandrini L, Pagan A, Caretto M, Ghelardi A, Amadori A, Origoni M, Barbero M, Raspagliesi F, Simoncini T, Vercellini P, Scambia G, Ciavattini A. In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes-Cervical Adenocarcinoma Study Group (CAS-Group). Cancers (Basel) 2023; 15:cancers15112876. [PMID: 37296839 DOI: 10.3390/cancers15112876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
It is unknown whether human papillomavirus (HPV) status impacts the prognosis of early stage cervical glandular lesions. This study assessed the recurrence and survival rates of in situ/microinvasive adenocarcinomas (AC) according to HPV status during a 5-year follow-up. The data were retrospectively analyzed in women with available HPV testing before treatment. One hundred and forty-eight consecutive women were analyzed. The number of HPV-negative cases was 24 (16.2%). The survival rate was 100% in all participants. The recurrence rate was 7.4% (11 cases, including four invasive lesions (2.7%)). Cox proportional hazards regression showed no difference in recurrence rate between HPV-positive and HPV-negative cases (p = 0.148). HPV genotyping, available for 76 women and including 9/11 recurrences, showed a higher relapse rate for HPV-18 than HPV-45 and HPV-16 (28.5%, 16.6%, and 9.52%, p = 0.046). In addition, 60% and 75% of in situ and invasive recurrences, respectively, were HPV-18 related. The present study showed that most ACs were positive for high-risk HPV, and the recurrence rate was unaffected by HPV status. More extensive studies could help evaluate whether HPV genotyping may be considered for recurrence risk stratification in HPV-positive cases.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS-Istituto Nazionale Tumori, 20133 Milan, Italy
| | - Francesco Sopracordevole
- Gynecologic Oncology Unit, IRCCS-Centro di Riferimento Oncologico di Aviano, 33081 Aviano, Italy
| | - Nicolò Clemente
- Gynecologic Oncology Unit, IRCCS-Centro di Riferimento Oncologico di Aviano, 33081 Aviano, Italy
| | - Giorgio Giorda
- Gynecologic Oncology Unit, IRCCS-Centro di Riferimento Oncologico di Aviano, 33081 Aviano, Italy
| | - Rosa Pasqualina De Vincenzo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Maria Teresa Evangelista
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Ermelinda Monti
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Alessi
- UOC Ostetricia Ginecologia, Dipartimento per la Salute della Donna e del Bambino, Azienda Ospedaliera-Università di Padova, 35128 Padova, Italy
| | - Lara Alessandrini
- Pathological Anatomy Unit, Department of Medicine DIMED, University of Padova, 35128 Padova, Italy
| | | | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, 54100 Massa, Italy
| | | | - Massimo Origoni
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| | - Maggiorino Barbero
- Department of Obstetrics and Gynecology, Asti Community Hospital, 14100 Asti, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS-Istituto Nazionale Tumori, 20133 Milan, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
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23
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Sammouri J, Wong MC, Lynn EJ, El Alam MB, Lo DK, Lin D, Harris TH, Karpinets TV, Court K, Napravnik TC, Wu X, Zhang J, Klopp AH, Ajami NJ, Colbert LE. Serial Genotyping of the Human Papillomavirus in Cervical Cancer: An Insight Into Virome Dynamics During Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00163-3. [PMID: 36801350 DOI: 10.1016/j.ijrobp.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is the primary driver of cervical cancer. Although studies in other malignancies correlated peripheral blood DNA clearance with favorable outcomes, research on the prognostic value of HPV clearance in gynecologic cancers using intratumoral HPV is scarce. We aimed to quantify the intratumoral HPV virome in patients undergoing chemoradiation therapy (CRT) and associate this with clinical characteristics and outcomes. METHODS AND MATERIALS This prospective study enrolled 79 patients with stage IB-IVB cervical cancer undergoing definitive CRT. Cervical tumor swabs collected at baseline and week 5 (end of intensity modulated radiation therapy) were sent for shotgun metagenome sequencing and processed via VirMAP, a viral genome sequencing and identification tool for all known HPV types. The data were categorized into HPV groups (16, 18, high risk [HR], and low risk [LR]). We used independent t tests and Wilcoxon signed-rank to compare continuous variables and χ2 and Fisher exact tests to compare categorical variables. Kaplan-Meier survival modeling was performed with log-rank testing. HPV genotyping was verified using quantitative polymerase chain reaction to validate VirMAP results using receiver operating characteristic curve and Cohen's kappa. RESULTS At baseline, 42%, 12%, 25%, and 16% of patients were positive for HPV 16, HPV 18, HPV HR, and HPV LR, respectively, and 8% were HPV negative. HPV type was associated with insurance status and CRT response. Patients with HPV 16+ and other HPV HR+ tumors were significantly more likely to have a complete response to CRT versus patients with HPV 18 and HPV LR/HPV-negative tumors. Overall HPV viral loads predominantly decreased throughout CRT, except for HPV LR viral load. CONCLUSIONS Rarer, less well-studied HPV types in cervical tumors are clinically significant. HPV 18 and HPV LR/negative tumors are associated with poor CRT response. This feasibility study provides a framework for a larger study of intratumoral HPV profiling to predict outcomes in patients with cervical cancer.
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Affiliation(s)
| | - Matthew C Wong
- Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | - Tatiana V Karpinets
- Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Xiaogang Wu
- Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianhua Zhang
- Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Nadim J Ajami
- Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Wang C, Li L, Wang F, Li X, Sun J, Li X, Lei T, Huang Q, Zhang G, Wang H, Li D, Jia J, Li C, Geng F, Yue J, Liu C. Single-cell transcriptomics dissects epithelial heterogeneity in HPV + cervical adenocarcinoma. J Med Virol 2023; 95:e28480. [PMID: 36609919 DOI: 10.1002/jmv.28480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
The intra- and intertumoral heterogeneity of epithelial cells in human papillomavirus (HPV+ ) cervical adenocarcinoma (CEAD) remains largely unknown. To investigate this issue, we performed single-cell RNA sequencing on 19 229 epithelial cells sorted from three tumor samples of three patients with HPV+ CEAD. Six epithelial subclusters (Epi1-Epi6) were identified that showed distinct gene expression. Among these, Epi1 and Epi4 had apparent tumor hallmarks and metabolic activities. Epi1 was highly enriched in hallmarks of hypoxia, IL2/STAT5 signaling, retinol metabolism, glycolysis, and arachidonic acid metabolism, while Epi4 was highly enriched in hallmarks of G2M checkpoint, E2F targets, DNA repair, PI3K/AKT/MTOR signaling, glycolysis, fatty acid degradation, TCA cycle, and glutathione metabolism. We also investigated intertumoral epithelial heterogeneity and found that Patient 1 was highly enriched for KRAS signaling and angiogenesis, while Patient 2 was highly enriched for epithelial-mesenchymal transition and TGF-β signaling, and Patient 3 was highly enriched for hypoxia, DNA repair, G2M checkpoint, and E2F targets. Using single-cell RNA sequencing, we revealed the intra- and intertumoral heterogeneity of epithelial cells in HPV+ CEAD, providing insights into the importance of personalized treatment for patients with HPV+ CEAD.
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Affiliation(s)
- Cong Wang
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,The Laboratory of Medical Science and Technology Innovation Center (Institute of Translational Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences) of China, Jinan, China
| | - Fuhao Wang
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xia Li
- Department of Obstetrics and Gynecology, Heze Municipal Hospital, Heze, China
| | - Jujie Sun
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaohui Li
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tianyu Lei
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingyu Huang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guangyu Zhang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Hongqing Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dapeng Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jue Jia
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chunyan Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Feng Geng
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinbo Yue
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chao Liu
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Insulin-induced gene 2 expression is associated with cervical adenocarcinoma malignant behavior. Mol Biol Rep 2023; 50:1553-1563. [PMID: 36515824 DOI: 10.1007/s11033-022-08095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The incidence of cervical adenocarcinoma (CA) as a malignant tumor has increased over the past few decades due to its low detection rate and malignant biological behaviors. Insulin-induced gene 2 (INSIG2), a membrane protein of the endoplasmic reticulum (ER), plays a crucial role in cancer progression. However, there is little known about the connection between INSIG2 and CA. METHODS The Human Protein Atlas (HPA) and the Cancer Genome Atlas (TCGA) Cervical Cancer (CESC) data were applied to study the alteration in INSIG2 expression. Biological functions were performed to test the change of malignant behavior. Bioinformatics analysis was conducted to explore the potential affection of INSIG2 in CA progression. RESULTS Our study confirmed that the high INSIG2 expression levels had a poor prognosis. INSIG2-knockdown inhibited the CA cell proliferation, migration, and invasion of CA cells while downregulating the epithelial-mesenchymal transition (EMT)-associated gene expression levels. Moreover, the enrichment analysis of DEGs showed more potential functions of INSIG2 in the CA progression. CONCLUSION We found that INSIG2 knockdown may play a suppressor role in the CA progression, and may provide the potential functional influence in inhibiting of CA development.
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Bae BK, Cho WK, Kim BG, Choi CH, Kim TJ, Lee YY, Lee JW, Park W. Patterns and risk factors of recurrence in low-risk early-stage cervical adenocarcinoma treated with surgery alone: implications on risk group stratification. Int J Gynecol Cancer 2022; 32:1524-1530. [PMID: 36368708 DOI: 10.1136/ijgc-2022-003971] [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: 11/13/2022] Open
Abstract
OBJECTIVE Cervical adenocarcinoma has poorer outcomes compared with squamous cell carcinoma; however, treatment is identical irrespective of histologic sub-types. This study aimed to investigate the patterns and risk factors of recurrence following surgery alone for low-risk early-stage cervical adenocarcinoma. METHODS We retrospectively reviewed patients who underwent surgery alone for low-risk early-stage cervical adenocarcinoma between January 2001 and December 2018 in a single institution. Baseline clinicopathological characteristics were collected to identify the factors associated with recurrence-free survival. RESULTS A total of 252 patients met the inclusion criteria. Most patients underwent radical hysterectomy (218 patients, 86.5%) and had usual type endocervical adenocarcinoma (190 patients, 75.4%). The International Federation of Gynecology and Obstetrics 2018 stage was IA1 in 72 patients (27.4%), IA2 in 58 (22.1%), IB1 in 51 (19.4%), and IB2 in 71 patients (27.0%). With a median follow-up of 70.4 months (range 6.2-252.5 months), 5-year survival rates were as follows: locoregional recurrence-free survival, 93.0%; recurrence-free survival, 89.6%; overall survival, 94.7%. The recurrence patterns were local in nine patients (32.1%), regional in five patients (17.8%), distant in 10 patients (35.7%), local and distant in one patient (3.6%), regional and distant in two patients (7.2%), and locoregional and distant in one patient (3.6%). In multivariable analysis, negative human papillomavirus (HPV) status (HR 7.314; p<0.001) and deep cervical stromal invasion (HR 5.110; p=0.003) were associated with poor locoregional recurrence-free survival. Patients were stratified based on the number of risk factors and a statistically significant difference in locoregional recurrence-free survival was observed: 5-year survival rates of 99.0%, 84.2%, and 50.0% for patients with 0, 1, and 2 risk factors (0 vs 1, p=0.001; 1 vs 2, p=0.011). CONCLUSION Surgery alone for low-risk early-stage cervical adenocarcinoma was associated with favorable outcomes over a long follow-up period. Patients with the highest risk of recurrence were those with a negative HPV status and deep cervical stromal invasion. Additional management following surgery may be considered in patients with these risk factors.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
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Zhang S, Wang H, Liu J, Tao T, Zeng Z, Wang M. RGS1 and related genes as potential targets for immunotherapy in cervical cancer: computational biology and experimental validation. J Transl Med 2022; 20:334. [PMID: 35879796 PMCID: PMC9310486 DOI: 10.1186/s12967-022-03526-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background Effective treatment is needed for advanced, inoperable, or chemotherapy-resistant cervical cancer patients. Immunotherapy has become a new treatment modality for cervical cancer patients, and there is an urgent need to identify additional targets for cervical cancer immunotherapy. Methods In this study the core gene, RGS1, which affects immune status and the FIGO stage of cervical cancer patients was identified by WGCNA analysis and differential analysis using TCGA database. 10 related genes interacting with RGS1 were identified using PPI network, and the functional and immune correlations were analyzed. Based on the expression of RGS1 and related genes, the consensus clustering method was used to divide CESC patients into two groups (group 1, high expression of RGS1; group 2, low expression of RGS1). Then, the functional enrichment analysis was used to search for the functional differences in differentially expressed genes (DEGs) between group 1 and group 2. Immune infiltration analysis was performed using ESTIMATE, CIBERSORT, and ssGSEA, and the differences in expression of immune checkpoint inhibitors (ICIs) targets were assessed between the two groups. We investigated the effect of RGS1 on the clinical relevance of CESC patients, and experimentally verified the differences in RGS1 expression between cervical cancer patient tissues and normal cervical tissues, the role of RGS1 in cell function, and the effect on tumor growth in tumor-bearing mice. Results We found that RGS1 was associated with CD4, GNAI3, RGS2, GNAO1, GNAI2, RGS20, GNAZ, GNAI1, HLA-DRA and HLA-DRB1, especially CD4 and RGS2. Functional enrichment of DEGs was associated with T cell activation. Compared with group 2, group 1 had stronger immune infiltration and higher ICI target expression. RGS1 had higher expression in cervical cancer tissues than normal tissues, especially in HPV-E6 positive cancer tissues. In cervical cancer cell lines, knockdown of RGS1 can inhibited cell proliferation, migration, invasion, and tumor growth in nude mice and promoted apoptosis. Conclusions RGS1, as an oncogenic gene of cervical cancer, affects the immune microenvironment of patients with cervical cancer and may be a target of immunotherapy.
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Ehmann S, Sassine D, Straubhar AM, Praiss AM, Aghajanian C, Alektiar KM, Broach V, Cadoo KA, Jewell EL, Boroujeni AM, Kyi C, Leitao MM, Mueller JJ, Murali R, Bhaloo SI, O'Cearbhaill RE, Park KJ, Sonoda Y, Weigelt B, Zamarin D, Abu-Rustum N, Friedman CF. Gastric-type adenocarcinoma of the cervix: Clinical outcomes and genomic drivers. Gynecol Oncol 2022; 167:458-466. [PMID: 36253302 PMCID: PMC10155605 DOI: 10.1016/j.ygyno.2022.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gastric-type endocervical adenocarcinoma (GEA) is a rare form of cervical cancer not associated with human papilloma virus (HPV) infection. We summarize our experience with GEA at a large cancer center. METHODS Clinical and demographic information on all patients diagnosed with GEA between June 1, 2002 and July 1, 2019 was obtained retrospectively from clinical charts. Kaplan-Meier survival analysis was performed to describe progression-free survival (PFS) and overall survival (OS). Tumors from a subset of patients underwent next generation sequencing (NGS) analysis. RESULTS A total of 70 women with GEA were identified, including 43 who received initial treatment at our institution: of these 4 (9%) underwent surgery alone, 15 (35%) underwent surgery followed by adjuvant therapy, 10 (23%) were treated with definitive concurrent chemoradiation (CCRT), 7 (16%) with chemotherapy alone, and 3 (7%) with neoadjuvant CCRT and hysterectomy with or without chemotherapy. One-third (n = 14) of patients experienced disease progression, of whom 86% (n = 12) had prior CCRT. The median PFS and OS for patients with stage I GEA were 107 months (95% CI 14.8-199.2 months) and 111 months (95% CI 17-205.1 months) respectively, compared to 17 months (95% CI 5.6-28.4 months) and 33 months (95% CI 28.2-37.8 months) for patients with stages II-IV, respectively. On NGS, 4 patients (14%) had ERBB2 alterations, including 2 patients who received trastuzumab. CONCLUSIONS GEA is an aggressive form of cervical cancer with poor PFS and OS when diagnosed at stage II or later. Further investigation is needed to identify the optimal management approach for this rare subtype.
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Affiliation(s)
- Sarah Ehmann
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dib Sassine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alli M Straubhar
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aaron M Praiss
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Karen A Cadoo
- St. James's Hospital Dublin, Trinity St. James's Cancer Institute, Dublin 8 DO8 NHY1, Ireland
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Amir Momeni Boroujeni
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chrisann Kyi
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rajmohan Murali
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Shirin Issa Bhaloo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Kay J Park
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dmitriy Zamarin
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Nadeem Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Claire F Friedman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
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Wang Q, Xu Y. Comprehensive analysis of cuproptosis-related lncRNAs model in tumor immune microenvironment and prognostic value of cervical cancer. Front Pharmacol 2022; 13:1065701. [DOI: 10.3389/fphar.2022.1065701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
Cervical cancer (CC) is the fourth leading gynecological malignancy in females worldwide. Cuproptosis, a form of cell death induced by copper, elicits a novel therapeutic strategy in anticancer therapy. Nonetheless, the effects of cuproptosis-related lncRNAs in CC remain unclear. Therefore, we aim to investigate cuproptosis-related lncRNAs, develop a risk model for prognostic prediction, and elucidate the immunological profile of CC. Transcription profiles and clinical follow-up data of CC were retrieved from The Cancer Genome Atlas (TCGA) database. Afterward, the risk model was built by distinguishing prognostic cuproptosis-related lncRNAs using the least absolute shrinkage and selection operator (LASSO) Cox regression. The correctness of the risk model was validated, and a nomogram was established followed by tumor immune microenvironment analysis. Tumor immune dysfunction and exclusion (TIDE) scores were used to assess immunotherapy response, and anticancer pharmaceutical half-maximal inhibitory concentration (IC50) prediction was performed for potential chemotherapy medicines. Finally, through coexpression analysis, 199 cuproptosis-related lncRNAs were collected. A unique risk model was generated using 6 selected prognostic cuproptosis-related lncRNAs. The risk score performed a reliable independent prediction of CC survival with higher diagnostic effectiveness compared to generic clinical characteristics. Immunological cell infiltration investigation indicated that the risk model was substantially linked with CC patients’ immunology, and the low-risk patients had lower TIDE scores and increased checkpoint expression, suggesting a stronger immunotherapy response. Besides, the high-risk group exhibited distinct sensitivity to anticancer medications. The immune-related progression was connected to the differentially expressed genes (DEGs) between risk groups. Generally, the risk model comprised 6 cuproptosis-related lncRNAs that may help predict CC patients’ overall survival, indicate immunocyte infiltration, and identify individualized treatment.
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Giannella L, Di Giuseppe J, Delli Carpini G, Grelloni C, Fichera M, Sartini G, Caimmi S, Natalini L, Ciavattini A. HPV-Negative Adenocarcinomas of the Uterine Cervix: From Molecular Characterization to Clinical Implications. Int J Mol Sci 2022; 23:ijms232315022. [PMID: 36499345 PMCID: PMC9735497 DOI: 10.3390/ijms232315022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women. It is the leading cause of female deaths in developing countries. Most of these cervical neoplasms are represented by squamous lesions. Cervical adenocarcinoma causes about a quarter of cervical cancers. In contrast to squamous lesions, cervical glandular disease is HPV-negative in about 15-20% of cases. HPV-negative cervical adenocarcinomas typically present in advanced stages at clinical evaluation, resulting in a poorer prognosis. The overall and disease-free survival of glandular lesions is lower than that of squamous lesions. Treatment options require definitive treatments, as fertility-sparing is not recommended. Moreover, the impact of HPV vaccination and primary HPV screening is likely to affect these lesions less; hence, the interest in this challenging topic for clinical practice. An updated review focusing on clinical and molecular characterization, prognostic factors, and therapeutic options may be helpful for properly managing such cervical lesions.
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Sun Q, Wang L, Zhang C, Hong Z, Han Z. Cervical cancer heterogeneity: a constant battle against viruses and drugs. Biomark Res 2022; 10:85. [PMCID: PMC9670454 DOI: 10.1186/s40364-022-00428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022] Open
Abstract
Cervical cancer is the first identified human papillomavirus (HPV) associated cancer and the most promising malignancy to be eliminated. However, the ever-changing virus subtypes and acquired multiple drug resistance continue to induce failure of tumor prevention and treatment. The exploration of cervical cancer heterogeneity is the crucial way to achieve effective prevention and precise treatment. Tumor heterogeneity exists in various aspects including the immune clearance of viruses, tumorigenesis, neoplasm recurrence, metastasis and drug resistance. Tumor development and drug resistance are often driven by potential gene amplification and deletion, not only somatic genomic alterations, but also copy number amplifications, histone modification and DNA methylation. Genomic rearrangements may occur by selection effects from chemotherapy or radiotherapy which exhibits genetic intra-tumor heterogeneity in advanced cervical cancers. The combined application of cervical cancer therapeutic vaccine and immune checkpoint inhibitors has become an effective strategy to address the heterogeneity of treatment. In this review, we will integrate classic and recently updated epidemiological data on vaccination rates, screening rates, incidence and mortality of cervical cancer patients worldwide aiming to understand the current situation of disease prevention and control and identify the direction of urgent efforts. Additionally, we will focus on the tumor environment to summarize the conditions of immune clearance and gene integration after different HPV infections and to explore the genomic factors of tumor heterogeneity. Finally, we will make a thorough inquiry into completed and ongoing phase III clinical trials in cervical cancer and summarize molecular mechanisms of drug resistance among chemotherapy, radiotherapy, biotherapy, and immunotherapy.
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Affiliation(s)
- Qian Sun
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Liangliang Wang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Cong Zhang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhenya Hong
- grid.33199.310000 0004 0368 7223Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhiqiang Han
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Li Y, Jia M, Cao L, Yu J, Gao H, Sun PL. Silva cumulative score and its relationship with prognosis in Endocervical adenocarcinoma. BMC Cancer 2022; 22:1172. [PMID: 36376880 PMCID: PMC9661810 DOI: 10.1186/s12885-022-10270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Silva system has been demonstrated to have a good predictive value of lymph node metastasis (LNM) in endocervical adenocarcinoma (EAC). Tumours were classified based on the highest identified pattern of invasion in this system, this may not exactly reflect the true situation when it presents with a “mixed pattern” in some cases. Recent study has shown that patients with lymphovascular invasion (LVI) have worse prognosis in EAC. Here we design a Silva cumulative score (SCS) system which also combined the LVI status to explore its prognostic role in EAC patients. Methods A total of 120 patients with EAC were included in this study. Clinicopathological characteristics were retrospectively retrieved from the medical records and follow-up data were obtained. The clinicopathological information included age at diagnosis, depth of invasion (DOI), LNM, LVI, Silva classification, and SCS. SCS is a classification system based on the sum score of different Silva pattern which is founded on morphological phenomena. The relationships between the pathological characteristics and prognoses were analyzed. Results According to the Silva system, 11 (9.2%), 22 (18.3%) and 87 (72.5%) patients had patterns A, B, and C, respectively. Patients with pattern C had the highest incidence of LVI and LNM (p < 0.05). Although the Kaplan-Meier curves demonstrated that survival decreased with increasing Silva classification for A-C cancers, there was no statistically significant difference [disease-free survival (DFS): p = 0.181; overall survival (OS): p = 0.205]. There were 45 cases presented as mixed-type of Silva patterns. According to the SCS, 23 cases (19.2%) were rated as grade I, 31 cases (25.8%) as grade II and 66 (55.0%) cases as grade III. Patients with SCS grade III had the highest incidence of LVI and LNM (p < 0.05). Kaplan–Meier analysis revealed that patients with higher SCS had significantly shorter DFS and OS than those with lower SCS (p < 0.05). High SCS was an independent predictor of poorer OS and DFS (p < 0.05) in patients with EAC. Conclusions The application of the Silva system could effectively predict the LNM of patients and may be helpful in selecting an appropriate surgical procedure. The SCS system we designed showed a good predictive value for DFS and OS in EAC.
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Bulutay P, Haberal N, Özen Ö, Erdem Ö, Zeren EH, Kulac İ, Taskiran Ç, Vatansever D, Ayhan A, Kapucuoğlu N. Reproducibility of Morphologic Parameters of the International Endocervical Adenocarcinoma Criteria and Classification System and Correlation With Clinicopathologic Parameters: A Multi-Institutional Study. Int J Gynecol Pathol 2022; 41:447-458. [PMID: 34856570 DOI: 10.1097/pgp.0000000000000839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endocervical adenocarcinomas (ECAs) have been recently reclassified according to their morphologic features linked to etiology by the International Endocervical Adenocarcinoma Criteria and Classification (IECC) and this system is adopted by WHO 2020. This classification separates the ECAs as human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) subtypes. According to WHO 2020, high risk (HR)-HPV association can be histologically recognized by the presence of luminal mitoses and apoptosis. Therefore, investigating the reproducibility of the morphologic criteria of this new classification will be important in observing the recognizability of tumor types. Full slide sets of 94 ECAs were collected from 4 institutions in Turkey and reclassified on the basis of IECC/WHO 2020 criteria and the presence or absence of HR-HPV. HR-HPV presence was confirmed by HPV DNA in situ hybridization, p16 immunohistochemistry and in conflicted cases with real time-polymerase chain reaction. The final diagnoses were given based on the combination of the histologic evaluation and ancillary test results. Our cohort consisted of 73.4% HPVA and 26.6% HPVI cases. According to the WHO 2020 criteria 92.7% of HPVAs and 88% of HPVIs were easily classified. HPV DNA in situ hybridization was positive in 91.3% of the HPVAs and p16 was positive in all HPVAs, and also positive in 8% of the HPVIs. In conclusion, most of the ECAs can be diagnosed by their characteristic morphologic features by the WHO 2020 criteria. However, we want to emphasize that mitosis/apoptosis criteria may not be helpful especially in mucinous ECAs and ancillary tests for HR-HPV should be used in challenging cases.
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Kim SH, Basili T, Dopeso H, Cruz Paula AD, Bi R, Bhaloo SI, Pareja F, Li Q, da Silva EM, Zhu Y, Hoang T, Selenica P, Murali R, Chan E, Wu M, Derakhshan F, Maroldi A, Hanlon E, Ferreira CG, Lapa e Silva JR, Abu-Rustum NR, Zamarin D, Chandarlapaty S, Matrai C, Yoon JY, Reis-Filho JS, Park KJ, Weigelt B. Recurrent WWTR1 S89W mutations and Hippo pathway deregulation in clear cell carcinomas of the cervix. J Pathol 2022; 257:635-649. [PMID: 35411948 PMCID: PMC9881397 DOI: 10.1002/path.5910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/12/2022] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
Clear cell carcinoma (CCC) of the cervix (cCCC) is a rare and aggressive type of human papillomavirus (HPV)-negative cervical cancer with limited effective treatment options for recurrent or metastatic disease. Historically, CCCs of the lower genital tract were associated with in utero diethylstilbestrol exposure; however, the genetic landscape of sporadic cCCCs remains unknown. Here we sought to define the molecular underpinning of cCCCs. Using a combination of whole-exome, targeted capture, and RNA-sequencing, we identified pathogenic genetic alterations in the Hippo signaling pathway in 50% (10/20) of cCCCs, including recurrent WWTR1 S89W somatic mutations in 40% (4/10) of the cases harboring mutations in the Hippo pathway. Irrespective of the presence or absence of Hippo pathway genetic alterations, however, all primary cCCCs analyzed in this study (n = 20) harbored features of Hippo pathway deregulation at the transcriptomic and protein levels. In vitro functional analysis revealed that expression of the WWTR1 S89W mutation leads to reduced binding of TAZ to 14-3-3, promoting constitutive nuclear translocation of TAZ and Hippo pathway repression. WWTR1 S89W expression was found to lead to acquisition of oncogenic behavior, including increased proliferation, migration, and colony formation in vitro as well as increased tumorigenesis in vivo, which could be reversed by targeted inhibition of the TAZ/YAP1 complex with verteporfin. Finally, xenografts expressing WWTR1 S89W displayed a shift in tumor phenotype, becoming more infiltrative as well as less differentiated, and were found to be composed of cells with conspicuous cytoplasmic clearing as compared to controls. Our results demonstrate that Hippo pathway alterations are likely drivers of cCCCs and likely contribute to the clear cell phenotype. Therapies targeting this pathway may constitute a new class of treatment for these rare, aggressive tumors. © 2022 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Sarah H. Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thais Basili
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Higinio Dopeso
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rui Bi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Shirin Issa Bhaloo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fresia Pareja
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing Li
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edaise M. da Silva
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yingjie Zhu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy Hoang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Selenica
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rajmohan Murali
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Chan
- Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Wu
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fatemeh Derakhshan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ana Maroldi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Etta Hanlon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlos Gil Ferreira
- Oncoclinicas Institute for Research and Education, Sao Paulo, Brazil,Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nadeem R. Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarat Chandarlapaty
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cathleen Matrai
- Department of Pathology, Weill Cornell Medical Center, New York, NY, USA
| | - Ju-Yoon Yoon
- Department of Pathology, St Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jorge S. Reis-Filho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay J. Park
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Correspondence to: KJ Park or B Weigelt, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. or:
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Correspondence to: KJ Park or B Weigelt, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. or:
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Chen F, Chen L, Zhang Y, Shi L, Xu H, Song T. Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer. Front Oncol 2022; 12:895122. [PMID: 35936684 PMCID: PMC9352995 DOI: 10.3389/fonc.2022.895122] [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: 03/13/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the prognostic significance of adenocarcinoma (AC) with squamous cell carcinoma (SCC) on overall survival (OS) in patients with stage IIB-IVA cervical cancer (CC) treated by external beam radiotherapy (EBRT) and brachytherapy (BRT) with/without chemotherapy registered in the Surveillance, Epidemiology, and End Results database. Methods Data of eligible patients were extracted between 2004 and 2016. A univariate analysis was conducted using the cumulative incidence function (CIF) by considering competing events and compared using Gray’s test. The significant variables in univariate analysis were further evaluated in a multivariate analysis performed with the Fine-Gray regression model. Propensity score matching (PSM) analysis was also employed to reconfirm the results found in the present study. Results A total of 2,243 patients with SCC and 176 patients with AC were extracted from the database. The 5-year OS rates were 57.8% in the SCC group and 52.8% in the AC group. 149 patients died of causes other than CC—considered as competing events. Compared with the SCC group, patients diagnosed with AC had statistically significant worse 5-year OS rate before and after PSM. In the multivariate Fine-Gray regression model, the histological subtype of AC was proven as an independent prognostic factor associated with poorer OS before [hazard ratio (HR) = 1.340; 95% confidence interval (CI): 1.081-1.660; P = 0.007] and after [HR = 1.376; 95% CI: 1.107-1.711; P = 0.004] PSM. Conclusions The histological subtype of AC is significantly correlated with impaired OS as an independent prognostic variable in patients with stage IIB-IVA CC who received EBRT and BRT compared to patients with SCC. Future studies should incorporate effective and individualized treatment strategies into clinical decision-making to improve the unsatisfactory survival outcomes for patients with AC.
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Affiliation(s)
- Fangjie Chen
- Department of Outpatient Nursing, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Long Chen
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Zhang
- Department of Nursing (5-11 Ward), Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lei Shi
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hong’en Xu
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- *Correspondence: Hong’en Xu, ; Tao Song,
| | - Tao Song
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- *Correspondence: Hong’en Xu, ; Tao Song,
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Du X, Hu Y, Ji X, Sui L, Zheng Q, Song K, Lv T, Chen Y, Zhao H, Dai S, Zhao P, Yao Q. Membranous and nuclear staining of CLDN18 in HPV-independent and HPV-associated endocervical adenocarcinomas. Cancer Med 2022; 12:1441-1450. [PMID: 35861118 PMCID: PMC9883430 DOI: 10.1002/cam4.5029] [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: 05/02/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES A classification system for endocervical adenocarcinoma (ECA) based on high-risk human papillomavirus (HPV) status has been established; however, the immunohistochemical markers distinguishing HPV-independent and HPV-associated ECAs have not been fully described. Here, we aimed to characterize ECA immunopathological features. METHODS We evaluated the immunohistochemical profile of CLDN18, CDX2, PAX8, p16, p53, and CEA in 60 ECAs comprising 10 HPV-independent ECAs and 50 HPV-associated ECAs. Both the membranous and nuclear expression levels of CLDN18 were analyzed. RESULTS Membranous CLDN18 (CLDN18 [M]) was found to be expressed in the mucinous epithelium of all HPV-independent ECAs, including eight gastric-type ECAs (G-ECAs), one endometrioid ECA, and one clear cell ECA, but no nuclear CLDN18 (CLDN18 [N]) expression was detected in HPV-independent ECAs. Among HPV-associated ECAs, CLDN18 (M) expression levels in intestinal-type (I-ECAs) and usual-type ECAs (U-ECAs) were significantly different from those in invasive stratified mucin-producing (iSMILE) carcinomas (p = 0.036). Positive CLDN18 (M) staining was present in 55.6% (5/9) of intestinal-type and 39.4% (13/33) of usual-type ECAs and was not present in iSMILE ECAs. Silva pattern C cancers expressed higher levels of CLDN18 (M) than Silva pattern A and B cancers (p = 0.004), whereas the CLDN18 (N) expression levels in cancers showing Silva pattern A were significantly higher than those in cancers exhibiting Silva patterns B and C (p < 0.001). CONCLUSION Membranous CLDN18 is expressed in ECAs and is particularly frequently expressed in HPV-independent ECAs, and membranous CLDN18 expression has potential as a therapeutic target. Nuclear staining of CLDN18 is a new immunohistochemical marker for diagnosing Silva pattern A HPV-associated ECAs and is associated with a good prognosis. Further studies should investigate the therapeutic and prognostic significance of membranous and nuclear CLDN18 expression and develop a related test that can be implemented in the clinical evaluation of ECAs.
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Affiliation(s)
- Xiuzhen Du
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Yanjiao Hu
- Department of PathologyThe affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Xiaoyu Ji
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Lei Sui
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Qingmei Zheng
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Kejuan Song
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Teng Lv
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Yulong Chen
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Han Zhao
- Department of PathologyThe affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Shuzhen Dai
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Peng Zhao
- Department of PathologyThe affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Qin Yao
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
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Wang Y, Chang RJ, Luo RZ, Yu J, Zhang X, Yang X, Quddus MR, Li L, Yang W, Liu A, Jiang Q, Zhao R, Zhu H, Zhou F, Wang Y, Sheng X, Liu LL, Wen YL, Banet N, Sung CJ, Qi Y, Bi R, Li M, Wang Y, Li J, Lin W, Wang Y, Rivera G, Chen H, Holloway SB, Fadare O, Liu J, Wang J, Lea J, Kong B, Zheng W. Tumoral Morphologic Features From Cervical Biopsies That Are Predictive of a Negligible Risk for Nodal Metastasis and Tumor Recurrence in Usual-type Cervical Adenocarcinomas: A Multi-institutional Study. Am J Surg Pathol 2022; 46:713-724. [PMID: 34753864 DOI: 10.1097/pas.0000000000001833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The metastatic or recurrent potential of localized human papillomavirus-associated endocervical adenocarcinoma (HPVA EAC) is difficult to predict, especially based upon biopsy alone. Recent analyses of small cohorts indicate that high tumor nuclear grade (TNG) and the presence of necrotic tumor debris (NTD) from HPVA EACs in cervical biopsy specimens are highly predictive of nodal metastasis (NM). In the present study, we aimed to investigate how reliably tumoral morphologic features from cervical biopsy specimens predict NM or tumor recurrence (TR) and patient outcomes in a large cohort of endocervical adenocarcinoma patients. A cohort comprised of 397 patients with HPVA EAC treated at 18 institutions was identified, and cervical biopsies were paired with their associated complete tumor resections for a total of 794 specimens. A variety of tumoral histologic features were examined for each paired specimen, including TNG (assessed on a 3-tiered scale of increasing abnormalities-TNG1, TNG2, TNG3) and NTD (defined by the presence of necrotic and apoptotic tumor cells within tumor glandular lumens admixed with granular and eosinophilic amorphous material and inflammatory cells), which were correlated with outcomes. The distribution of TNG in biopsies was as follows: 86 (21.7%) TNG1, 223 (56.2%) TNG2, and 88 (22.2%) TNG3. NTD was identified in 176 (44%) of the biopsy specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of a TNG1 assignment in the biopsy being predictive of the same assignment in the full resection were 0.82 (95% confidence interval [CI]: 0.7-0.9), 0.895 (0.86-0.93), 0.593 (0.48-0.696), and 0.96 (0.94-0.98), respectively. Respective values for an NTD-negative status were 0.89 (95% CI: 0.83-0.92), 0.715 (0.64-0.77), 0.72 (0.65-0.77), and 0.89 (0.83-0.93), respectively. Compared with the other cases in each category, both TNG1 and an NTD-negative status were each significantly associated with lower rates of NM (odds ratio for TNG1=0.245, 95% CI: 0.070-0.857, P=0.0277; for NTD=0.199, 95% CI: 0.094-0.421, P<0.0001) and TR (odds ratio for TNG1=0.225, 95% CI: 0.051-0.987, P=0.0479; for NTD=0.367, 95% CI: 0.171-0.786, P=0.0099) independent of depth of stromal invasion, lymphovascular invasion, tumor size, FIGO stage, and Silva pattern. Overall, 73/379 (19%) cases were both TNG1 and NTD-negative on the biopsy, and none of these 73 cases showed NM (0%), but a single case (1.4%) showed TR. In contrast, among the 324 biopsies with TNG2/3 and/or presence of NTD, 62 (19.1%) had NM, and 41 (12.9%) had TR. In summary, 2 variables in combination (ie, TNG1 and NTD-negative) identified a subset of HPVA EAC patients-∼19%-with a 0% frequency of nodal metastases and only 1.4% frequency of recurrence. Biopsies highly but imperfectly predicted these features. Nonetheless, these findings may potentially be of clinical utility in the risk stratification of patients with HPVA EACs. This may allow some patients with a minimal risk of nodal metastases and TR to be identified at the biopsy phase, thereby facilitating more personalized, possibly less aggressive treatment.
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Affiliation(s)
- Yue Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital
| | | | | | - Jing Yu
- Department of Pathology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine
| | - Xiaofei Zhang
- Department of Pathology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, Zhejiang Province
| | - Xianghong Yang
- Department of Pathology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province
| | - M R Quddus
- Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, Providence, RI
| | - Li Li
- Department of Pathology, Shandong University School of Basic Medical Sciences
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai
| | - Aijun Liu
- Department of Pathology, The Seventh Medical Center of Chinese PLA General Hospital
| | - Qingping Jiang
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province
| | - Ruijiao Zhao
- Department of Pathology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan Province
| | - Huiting Zhu
- Department of Pathology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine
| | - Feng Zhou
- Department of Pathology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, Zhejiang Province
| | - Yiying Wang
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital
| | - Xiujie Sheng
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province
| | | | | | - Natalie Banet
- Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, Providence, RI
| | - C J Sung
- Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, Providence, RI
| | - Yafei Qi
- Department of Pathology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province
| | - Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai
| | - Ming Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai
| | - Yun Wang
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinhang Li
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | | | | | | | | | - Oluwole Fadare
- Department of Pathology, University of California San Diego, La Jolla, CA
| | - Jihong Liu
- Gynecologic Oncology, Sun Yat-Sen University Cancer Center
| | | | - Jayanthi Lea
- Obstetrics and Gynecology
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong Province
| | - Wenxin Zheng
- Departments of Pathology
- Obstetrics and Gynecology
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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Identification and Validation of Invasion-Related Molecular Subtypes and Prognostic Features for Cervical Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1902289. [PMID: 35345518 PMCID: PMC8957037 DOI: 10.1155/2022/1902289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
Background As one of the main causes leading to female cancer deaths, cervical cancer shows malignant features of local infiltration and invasion into adjacent organs and tissues. This study was designed to categorize novel molecular subtypes according to cervical cancer invasion and screen reliable prognostic markers. Methods Invasion-related gene sets and expression profiles of invasion-related genes were collected from the CancerSEA database and The Cancer Genome Atlas (TCGA), respectively. Samples were clustered by nonnegative matrix factorization (NMF) to obtain different molecular subgroups, immune microenvironment characteristics of which were further systematically compared. Limma was employed to screen differentially expressed gene sets in different subtypes, followed by Lasso analysis for dimension reduction. Multivariate and univariate Cox regression analysis was performed to determine prognostic characteristics. The Kaplan-Meier test showed the prognostic differences of patients with different risks. Additionally, receiver operating characteristic (ROC) curves were applied to validate the prognostic model performance. A nomogram model was developed using clinical and prognostic characteristics of cervical cancer, and its prediction accuracy was reflected by calibration curve. Results This study filtered 19 invasion-related genes with prognosis significance in cervical cancer and 2 molecular subtypes (C1, C2). Specifically, the C1 subtype had an unfavorable prognosis, which was associated with the activation of the TGF-beta signaling pathway, focal adhesion, and PI3K-Akt signaling pathway. 875 differentially expressed genes were screened, and 8 key genes were finally retained by the dimension reduction analysis. An 8-gene signature was established as an independent factor predictive of the prognosis of cervical cancer. The signature performance was even stronger when combined with N stage. Conclusion Based on invasion-related genes, the present study categorized two cervical cancer subtypes with distinct TME characteristics and established an 8-gene marker that can accurately and independently predict the prognosis of cervical cancer.
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Talia KL, Arora R, McCluggage WG. Precursor Lesions of Cervical Clear Cell Carcinoma: Evidence For Origin From Tubo-Endometrial Metaplasia. Int J Gynecol Pathol 2022; 41:105-112. [PMID: 33770055 DOI: 10.1097/pgp.0000000000000785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical clear cell carcinoma (CCC) is an HPV-independent tumor historically associated with in-utero exposure to diethylstilboestrol. With the cessation of diethylstilboestro use, most contemporary cases are sporadic and of uncertain pathogenesis, with no established precursor lesion. Following the detection of 3 incidental "early" (FIGO stage IA1) cervical CCCs, all of which displayed adjacent tubo-endometrial metaplasia, we examined further cases, including resection specimens, of this tumor in an attempt to delineate potential precursors. We identified tubo-endometrial metaplasia in proximity to the tumor in 5 of 5 additional primary cervical CCCs, with some tubo-endometrial glands exhibiting subtle mild cytologic atypia. This observation adds to the sparse existing literature proposing tubo-endometrial metaplasia as a precursor to sporadic cervical CCC, with possible progression via an "atypical" transitional phase to malignancy. We also review the published literature regarding possible precursor lesions of primary cervical CCC.
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Estrogen receptor-positive adenocarcinoma of the cervix presenting during pregnancy: Two case reports and review of the literature. Gynecol Oncol Rep 2022; 39:100916. [PMID: 35036507 PMCID: PMC8753117 DOI: 10.1016/j.gore.2021.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/03/2022] Open
Abstract
Estrogen receptor or progesterone receptor positivity are unusual in cervical adenocarcinomas. Estrogen receptor positivity in pregnancy could be associated with a faster growth rate. Both patients presented remain free of recurrence after definitive treatment.
The incidence of adenocarcinoma of the cervix in pregnancy is exceptionally rare, and thus there is no consensus on its management. Here, we report two cases of adenocarcinoma of the cervix diagnosed in the context of pregnancy. In our first case, a patient referred to colposcopy for atypical glandular cells of undetermined significance was subsequently diagnosed with well differentiated endocervical adenocarcinoma on cone biopsy. Just prior to the cone biopsy, she was incidentally found to have a first trimester pregnancy loss. The patient subsequently underwent a radical hysterectomy and bilateral sentinel lymph node dissection. Final pathology revealed a stage 1B1 (FIGO 2009) well differentiated adenocarcinoma of the cervix. Interestingly, the tumour was positive for estrogen receptor, which is unusual for cervical adenocarcinoma. In our second case, a patient presented with a pedunculated, exophytic cervical neoplasm at 31 weeks GA with self-limiting antepartum hemorrhage. The primary lesion measured 52 mm in diameter on MRI and was amputated at the base during the patient’s elective repeat cesarean section. Final pathology revealed a stage IB2 (FIGO 2009) mucinous adenocarcinoma of the cervix. The patient subsequently underwent a radical hysterectomy and bilateral pelvic lymph node dissection 17 weeks after initial presentation. The depth of invasion was 2.2 mm, restricted to the inner third of the cervical wall, and there was no lymphovascular space invasion in the surgical specimen. Surgical margins, parametria, and lymph nodes were all negative for adenocarcinoma. This tumour was also found to be estrogen receptor/progesterone receptor (ER/PR) positive, again unusual for cervical adenocarcinoma. P16 was strongly positive and HPV DNA studies were also positive for human papilloma virus 18. The patient received adjuvant external beam radiotherapy to the pelvis and currently remains in remission.
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Key Words
- Adenocarcinoma
- CT, Computed Tomography
- Cervical cancer
- Cervix
- DFS, disease-free survival
- EBRT, External Beam RadioTherapy
- ER, Estrogen Receptor
- Estrogen receptor
- GA, Gestational Age
- HPVA, Human PapillomaVirus-Associated
- IECC, International Endocervical Adenocarcinoma Criteria and Classification
- IHC, Immuno-Histo-Chemistery
- LVSI, LymphoVascular Space Invasion
- MRI, Magnetic Resonance Imaging
- NOS, Not Otherwise Specified
- OS, Overall Survival
- PFS, Progression Free Survival
- PR, Progesterone Receptor
- Pregnancy
- SCC, Squamous Cell Carcinoma
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Yoshida H, Shiraishi K, Kato T. Molecular Pathology of Human Papilloma Virus-Negative Cervical Cancers. Cancers (Basel) 2021; 13:cancers13246351. [PMID: 34944973 PMCID: PMC8699825 DOI: 10.3390/cancers13246351] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women worldwide and is predominantly caused by infection with human papillomavirus (HPV). However, a small subset of cervical cancers tests negative for HPV, including true HPV-independent cancers and false-negative cases. True HPV-negative cancers appear to be more prevalent in certain pathological adenocarcinoma subtypes, such as gastric- and clear-cell-type adenocarcinomas. Moreover, HPV-negative cervical cancers have proven to be a biologically distinct tumor subset that follows a different pathogenetic pathway to HPV-associated cervical cancers. HPV-negative cervical cancers are often diagnosed at an advanced stage with a poor prognosis and are expected to persist in the post-HPV vaccination era; therefore, it is important to understand HPV-negative cancers. In this review, we provide a concise overview of the molecular pathology of HPV-negative cervical cancers, with a focus on their definitions, the potential causes of false-negative HPV tests, and the histology, genetic profiles, and pathogenesis of HPV-negative cancers.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
- Correspondence: ; Tel.: +81-3-3457-5201
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan;
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
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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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Wu C, Ma C, Yuan J, Zhou P. Exploration of potential therapeutic and prognostic value of CXC chemokines in cervical squamous cell carcinoma and endocervical adenocarcinoma based on bioinformatics analysis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:8201-8222. [PMID: 34814296 DOI: 10.3934/mbe.2021407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cervical cancer, as the second most common female malignancy, brings a great health burden to women worldwide. Cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) are the most common histological subtypes of cervical cancer. CXC chemokines (CXCLs) within the tumor microenvironment can modulate carcinogenesis and progression. The present study aimed to explore the therapeutic and prognostic value of different CXCLs in CESC. ONCOMINE, GEPIA, cBioPortal, TRRUST, GeneMANIA, STRING and TIMER were utilized to explore the expression, mutation and function of CXCLs in CESC, as well as their correlation with pathological and survival features of CESC patients. We found that the mRNA expression levels of CXCL1/8/9/10/11/13/16/17 in CESC were upregulated compared with normal cervical tissues, whereas CXCL12 was downregulated. No significant correlation was found between the expression levels and pathological stage of CESC patients. CESC patients with high expression of CXCL1/2/3/4/5/8 were significantly associated with poor overall survival, additionally, low mRNA level of CXCL3 was associated with better disease-free survival. Besides, a high mutation rate (43%) of CXCLs in CESC was observed. Depicted by co-expression analysis, the expression of CXCL1/2/3/6/8 showed a modest to strong correlation, while that of CXCL9/10/11/13 showed a very strong correlation. Differentially expressed CXCLs primarily functioned in chemokine signaling pathway and inflammation response, such as cell chemotaxis, chemokine activity and chemokine receptor binding. We also found the association of CXCLs with the tumor-infiltration of six types of immune cells (B cells, CD8+ T cells, CD4+ T cells, macrophages, neutrophils and dendritic cells) in CESC patients. The present study elucidated that CXCLs may have the potential to be novel therapeutic targets and prognosis predictors of CESC patients.
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Affiliation(s)
- Caiyun Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Cong Ma
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jing Yuan
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Pei Zhou
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Chen L, Lucas E, Zhang X, Liu Q, Zhuang Y, Lin W, Chen H, Zhou F. Programmed death-ligand 1 expression in human papillomavirus-independent cervical adenocarcinoma and its prognostic significance. Histopathology 2021; 80:338-347. [PMID: 34455625 DOI: 10.1111/his.14552] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
AIMS In the 2020 World Health Organization classification of female genital tumours, endocervical adenocarcinomas (ECAs) are subclassified into human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) groups on the basis of their distinct aetiologies and clinical behaviours. The aim of this study was to investigate programmed death-ligand 1 (PD-L1) expression and its prognostic value in HPVI ECA and HPVA ECA, and compare these between the two entities. METHODS AND RESULTS A total of 93 ECAs accessioned between 2013 and 2020 were selected for further analysis, including 48 usual-type HPVA ECAs and 45 HPVI ECAs. Then, we evaluated PD-L1 expression in whole tissue sections of these cases by using the tumour proportion score (TPS) and the combined positive score (CPS). Heterogeneous PD-L1 expression was observed in both HPVI ECAs and usual-type HPVA ECAs. However, no significant difference in PD-L1 expression was seen among different histological types of ECA when either the CPS or the TPS was used. Gastric-type ECA (GEA) was associated with higher clinical stage (P = 0.001), worse progression-free survival (PFS) (P = 0.008) and worse overall survival (OS) (P = 0.02) than usual-type HPVA ECA and non-GEA HPVI ECA. When the TPS was used, PD-L1-positive GEA was associated with significantly worse PFS (P = 0.03) and OS (P = 0.015) than PD-L1-negative GEA. CONCLUSIONS Our data show frequent PD-L1 expression in HPVI ECAs, supporting the potential role of the programmed cell death protein 1/PD-L1 pathway as a therapeutic target for these tumours. Our data also support PD-L1 as a negative prognostic marker associated with a potentially unfavourable outcome for GEAs.
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Affiliation(s)
- Lili Chen
- Department of Oncology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang Province, China
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, USA
| | - Xiaofei Zhang
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang Province, China
| | - Qin Liu
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang Province, China
| | - Yalin Zhuang
- Department of Oncology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang Province, China
| | - Wanrun Lin
- Department of Pathology, University of Texas Southwestern Medical Center, USA
| | - Hao Chen
- Department of Pathology, University of Texas Southwestern Medical Center, USA.,Department of Pathology, Parkland Hospital, Dallas, TX, USA
| | - Feng Zhou
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang Province, China
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Xiao M, Ma X, Ma F, Li Y, Zhang G, Qiang J. Whole-tumor histogram analysis of apparent diffusion coefficient for differentiating adenosquamous carcinoma and adenocarcinoma from squamous cell carcinoma in patients with cervical cancer. Acta Radiol 2021; 63:1415-1424. [PMID: 34382429 DOI: 10.1177/02841851211035915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Differentiating adenosquamous carcinoma (ASC) and adenocarcinoma (AC) from squamous cell carcinoma (SCC) precisely is crucial for treatment strategy and prognosis prediction in patients with cervical cancer (CC). PURPOSE To differentiate ASC and AC from SCC in patients with CC using the apparent diffusion coefficient (ADC) histogram analysis. MATERIAL AND METHODS A total of 118 patients with histologically diagnosed ASC, AC, and SCC were included. The ADC histogram parameters were extracted from ADC maps. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance of each ADC histogram parameter in differentiating the subtypes of CC. The predictors for histologic subtypes were further selected using univariate and multivariate logistic regression analyses. RESULTS The ADCmean, ADCmax, ADCP10, ADCP25, ADCP75, ADCP90, ADCmedian, and ADCmode of the ASC were significantly lower than those of the AC; and ADCkurtosis and ADCskewness of the ASC were lower than those of the SCC. The ADCmean, ADCmax, ADCP10, ADCP25, ADCP75, ADCP90, ADCmedian, and ADCmode of AC were significantly higher than those of the SCC. The ADCP10 and ADCP10 + diameter yielded the AUCs of 0.753 and 0.778 in differentiating ASC from AC. The ADCmedian and ADCmedian + diameter yielded the AUCs of 0.807 and 0.838 in differentiating AC from SCC. The ADCskewness yielded the AUC of 0.713 in differentiating ASC from SCC. CONCLUSION The ADCP10 and ADCP10 + diameter, ADCmedian, and ADCmedian + diameter performed well in differentiating ASC from AC and AC from SCC, respectively. However, ADCskewness exhibited a limited ability in differentiating ASC from SCC.
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Affiliation(s)
- Meiling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
| | - Xiaoliang Ma
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
| | - Fenghua Ma
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Yongai Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
| | - Guofu Zhang
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
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Arezzo F, Cormio G, Loizzi V, Cazzato G, Cataldo V, Lombardi C, Ingravallo G, Resta L, Cicinelli E. HPV-Negative Cervical Cancer: A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11060952. [PMID: 34073478 PMCID: PMC8229781 DOI: 10.3390/diagnostics11060952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer (CC) is the fourth most frequent cancer in women worldwide. HPV infection is associated with the majority of CC cases, but a small proportion of CCs actually test negative for HPV. The prevalence of HPV among CC histotypes is very different. It has been suggested that HPV-negative CC may represent a biologically distinct subset of tumors, relying on a distinct pathogenetic pathway and carrying a poorer prognosis, than HPV-positive CCs. Although, the discordance in terms of sensitivity and specificity between different HPV tests as well as the potential errors in sampling and storing tissues may be considered as causes of false-negative results. The identification of HPV-negative CCs is essential for their correct management. The aim of this narrative review is to summarize the clinical and pathological features of this variant. We also discuss the pitfalls of different HPV tests possibly leading to classification errors.
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Affiliation(s)
- Francesca Arezzo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
- Correspondence: (F.A.); (G.I.); Tel.: +39-3274961788 (F.A.); +39-3388536505 (G.I.)
| | - Gennaro Cormio
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Vera Loizzi
- Obstetrics and Gynecology Unit, Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
| | - Viviana Cataldo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Claudio Lombardi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
- Correspondence: (F.A.); (G.I.); Tel.: +39-3274961788 (F.A.); +39-3388536505 (G.I.)
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
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Liu H, Ye X, Li D, Yao Q, Li Y. Incidence, clinical risk and prognostic factors for liver metastasis in patients with cervical cancer: a population-based retrospective study. BMC Cancer 2021; 21:421. [PMID: 33863313 PMCID: PMC8052699 DOI: 10.1186/s12885-021-08127-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cervical cancer is one of the most frequent malignancies in women, particularly metastasis resulting in a poor prognosis. However, the clinical characteristics of cervical cancer patients with advanced liver metastasis have not been well investigated. We aimed to evaluate the incidence, clinical risk and prognostic factors for hepatic metastasis in cervical cancer patients. MATERIALS AND METHODS The clinical features of patients diagnosed with cervical cancer were collected from the Surveillance, Epidemiology and End Result (SEER) public cancer database between 2010 and 2015. Multivariate logistic and Cox regression models were performed to identify potential risk and prognostic factors for liver metastasis in patients with cervical cancer. RESULTS A total of 431 patients (2.32%) developed liver metastasis in our analysis. The following characteristics were significantly associated with the development of liver metastasis: black ethnicity, uninsured status, higher tumor stage, poorer differentiated grade, non-squamous histology, non-surgery of primary site, patients with any additional lung, bone, and brain metastasis. Multivariate Cox regression showed that patients with additional lung metastasis, without radiotherapy, and without chemotherapy were negatively correlated with overall survival. Concurrent chemotherapy and radiotherapy was a favorable prognostic factor to improve overall survival, and chemotherapy showed to increase cause-specific survival. Additional lung metastasis was an independent characteristic for both risk and prognostic factors for hepatic metastasis in patients with cervical cancer. CONCLUSION Our results found several potential clinical features that may be used to assess the risk and prognosis of liver metastasis in patients with cervical cancer. These associated factors may provide clinical indications for the early identification and treatment of cervical cancer patients with hepatic metastasis.
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Affiliation(s)
- Hang Liu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China
| | - Xiangsen Ye
- Department of Clinical Laboratory, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China
| | - Qian Yao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China.
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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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Park KJ, Roma A, Singh N, Gilks CB, Oliva E, Abu-Rustum N, Ramirez PT, McCluggage WG. Tumor Staging of Endocervical Adenocarcinoma: Recommendations From the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S92-S101. [PMID: 33570866 PMCID: PMC7969160 DOI: 10.1097/pgp.0000000000000758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) updated its staging system for cervical cancer in 2018 with changes that affect size criteria for early stage disease, as well as including pathology and radiology in addition to clinical assessment to be used in staging. Lymph node involvement was also included in the staging system. In early stage disease, pathologic findings are crucial in determining stage, which in turn determine treatment and prognosis for the patient. Therefore, it is imperative that there are unified and consistent methods and recommendations for assessing and reporting pathologic parameters for accurate staging. We describe the changes in the revised FIGO staging scheme and discuss controversial issues in cervical cancer staging from a pathologic perspective. We also provide practical recommendations regarding these parameters based on literature review and/or expert opinion/consensus.
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50
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Wong RWC, Ng JHY, Han KC, Leung YP, Shek CM, Cheung KN, Choi CKM, Tse KY, Ip PPC. Cervical carcinomas with serous-like papillary and micropapillary components: illustrating the heterogeneity of primary cervical carcinomas. Mod Pathol 2021; 34:207-221. [PMID: 32699256 DOI: 10.1038/s41379-020-0627-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/07/2023]
Abstract
Recent changes in the classification of cervical adenocarcinomas have re-categorized serous carcinoma as potentially nonexistent. However, clinical and pathological profiles of cervical adenocarcinomas with serous-like morphological features have not been systematically evaluated using the latest taxonomy and biomarkers. We studied 14 cases of primary cervical carcinomas with serous-like morphologies (papillary and micropapillary patterns). None of these cases exhibited evidence of serous carcinoma involving the upper tracts. Patient ages ranged between 34 and 86 years, most presented with abnormal uterine bleeding. Histologically, ten cases were classified as human papillomavirus (HPV)-associated carcinomas (eight usual-type endocervical adenocarcinomas and two adenosquamous carcinomas), of which six exhibited a papillary pattern and four had a micropapillary pattern. The four remaining cases were HPV-independent gastric-type adenocarcinomas, which displayed a papillary pattern in one case and a micropapillary pattern in three others. All ten HPV-associated carcinomas displayed block positive p16 and wild-type p53 by immunohistochemistry, with nine of them confirmed by HPV testing. Two of the four gastric-type adenocarcinomas had mutation-type p53, one of which also being p16 block positive. HER2 overexpression was demonstrated in 3/14 (21.4%) cases (2 HPV-associated and 1 HPV-independent). PD-L1 expression was identified in 4/10 (40%) cases, all HPV-associated. Targeted next-generation sequencing was performed in two cases with a micropapillary pattern, revealing a missense variant in ATM in an HPV-associated tumor and missense variants in TP53 and SMARCB1 in an HPV-independent tumor. The results demonstrated that primary endocervical adenocarcinomas can mimic the appearance of serous carcinoma, while not representing serous carcinoma. Serous-like papillary and micropapillary patterns may be present in both HPV-associated and HPV-independent cervical carcinomas, but none of the cases studied were unequivocally serous upon detailed analysis. Our findings support the exclusion of "cervical serous carcinoma" from existing classifications of cervical adenocarcinoma.
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Affiliation(s)
- Richard Wing-Cheuk Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. .,Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Joshua Hoi Yan Ng
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kam Chu Han
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Yuen Ping Leung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Chiu Man Shek
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kin Nam Cheung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Carmen Ka Man Choi
- Department of Obstetrics & Gynecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Ka Yu Tse
- Department of Obstetrics & Gynecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Philip P C Ip
- Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong
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