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Zare SY, Fard EV, Fadare O. GATA3 immunohistochemistry as a diagnostic adjunct for differentiated vulvar intraepithelial neoplasia: utility and limitations. Hum Pathol 2023; 139:55-64. [PMID: 37454993 DOI: 10.1016/j.humpath.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Herein, the authors evaluate the diagnostic utility and limitations of GATA3 immunohistochemistry for the distinction of differentiated vulvar intraepithelial neoplasia (dVIN) from its potential mimics. Immunohistochemical studies for GATA3, p53, and p16 were performed on 124 pathologic vulvar tissues, inclusive of dVIN (n = 21), vulvar aberrant maturation (n = 10), high-grade squamous intraepithelial lesion (HSIL) (n = 44), and 49 non-neoplastic vulvar dermatoses of various types. GATA3 expression was scored using a modification of previously proposed criteria: pattern 0 (no significant loss of basal layer staining, >75% staining), pattern 1 (25-75% staining), and pattern 2 (<25% staining). With the exception of lichen sclerosus, 8% of which showed pattern 1 or 2 staining, all other non-neoplastic lesions showed pattern 0 expression. Aberrant GATA3 expression (i.e., patterns 1 or 2) was present in 90% of dVIN cases (2 [9.5%], 3 [14.3%], 16 [76.2%] with patterns 0, 1, and 2 respectively), 90% of vulvar aberrant maturation cases (1 [10%],7 [70%], 2 [20%] with patterns 0, 1, and 2 respectively), and 15.9% of HSIL cases (84.1% pattern 0; 2.3% pattern 1; 13.6% pattern 2). All HSIL cases were p16 positive, including the 7 pattern 1 and 2 cases. All cases of dVIN-like HSIL were pattern 0, and all (n = 2) cases of HSIL-like (basaloid) dVIN were pattern 2 (both of the latter cases displayed complete absence of epidermal staining). Only 1 dVIN case was both pattern 0 and p53-wild-type. We conclude that GATA3 is useful for the distinction of dVIN from non-neoplastic dermatoses and from HSIL, but is best used as part of a panel that includes p53 and p16 to mitigate its limitations.
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Affiliation(s)
- Somaye Y Zare
- Department of Pathology, University of California San Diego, San Diego, CA 92093, USA
| | - Elmira Vaziri Fard
- Department of Pathology, University of California San Diego, San Diego, CA 92093, USA
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA 92093, USA.
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Zhang T, Zhu Y, Luo J, Li J, Niu S, Chen H, Zhou F. An integrated model for prognosis in vulvar squamous cell carcinoma. BMC Cancer 2023; 23:534. [PMID: 37308869 DOI: 10.1186/s12885-023-11039-2] [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] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Vulvar squamous cell carcinoma (VSCC) is a relatively rare gynecologic cancer. Unlike cervical squamous cell carcinoma (CSCC), in which nearly all cases are caused by HPV infection, most VSCCs are HPV-independent. Patients with VSCC also have worse overall survival (OS) than those with CSCC. Unlike CSCC, the risk factors of VSCC have not been extensively studied. Here, we investigated the prognostic values of clinicopathological parameters as well as biomarkers in patients with VSCC. METHODS In total, 69 cases of VSCC accessions were selected for analysis between April 2010 and October 2020. The risk factors of VSCC were screened using Cox models to establish nomograms for predicting survival outcomes. RESULTS Following the multivariate COX model for OS, independent predictors including advanced age (hazard ratio [HR] 5.899, p = 0.009), HPV positivity (HR 0.092, p = 0.016), high Ki-67 index (HR 7.899, p = 0.006), PD-L1-positivity (HR 4.736, p = 0.077), and CD8 + tumor-infiltrating lymphocytes (TILs) (HR 0.214, p = 0.024) were included in the nomogram for OS; multivariate COX model for progression-free survival (PFS) was used to screen prognostic factors including advanced age (HR 2.902, p = 0.058), lymph node metastasis (HR 5.038, p = 0.056), HPV positivity (HR 0.116, p = 0.011), high Ki-67 index (HR 3.680, p = 0.042), PD-L1-positivity (HR 5.311, p = 0.045), and CD8 + TILs (HR 0.236, p = 0.014) to establish the PFS nomogram model. Based on the C-index (0.754 for OS and 0.754 for PFS) from our VSCC cohort and the corrected C-index (0.699 for OS and 0.683 for PFS) from an internal validation cohort, the nomograms demonstrated good predictive and discriminative ability. Kaplan-Meier curves also supported the excellent performance of the nomograms. CONCLUSION Our prognostic nomograms suggested that (1) shorter OS and PFS were associated with PD-L1-positivity, high Ki-67 index, and low CD8 + TILs; (2) HPV-independent tumors were associated with poorer survival outcome, and mutant p53 status showed no prognostic significance.
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Affiliation(s)
- Tao Zhang
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, China
| | - Yingfan Zhu
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, China
| | - Jie Luo
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, China
| | - Juanqing Li
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, China
| | - Shuang Niu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Hao Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Feng Zhou
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, China.
- Department of Pathology, International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Gupta I, Vranic S, Al-Thawadi H, Al Moustafa AE. Fascin in Gynecological Cancers: An Update of the Literature. Cancers (Basel) 2021; 13:cancers13225760. [PMID: 34830909 PMCID: PMC8616296 DOI: 10.3390/cancers13225760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Fascin, an actin-binding protein, is upregulated in different types of human cancers. It is reportedly responsible for increasing the invasive and metastatic ability of cancer cells by reducing cell–cell adhesions. This review provides a brief overview of fascin and its interactions with other genes and oncoviruses to induce the onset and progression of cancer. Abstract Fascin is an actin-binding protein that is encoded by the FSCN1 gene (located on chromosome 7). It triggers membrane projections and stimulates cell motility in cancer cells. Fascin overexpression has been described in different types of human cancers in which its expression correlated with tumor growth, migration, invasion, and metastasis. Moreover, overexpression of fascin was found in oncovirus-infected cells, such as human papillomaviruses (HPVs) and Epstein-Barr virus (EBV), disrupting the cell–cell adhesion and enhancing cancer progression. Based on these findings, several studies reported fascin as a potential biomarker and a therapeutic target in various cancers. This review provides a brief overview of the FSCN1 role in various cancers with emphasis on gynecological malignancies. We also discuss fascin interactions with other genes and oncoviruses through which it might induce cancer development and progression.
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Affiliation(s)
- Ishita Gupta
- Department of Basic Medical Science, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (I.G.); (S.V.); (H.A.-T.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
| | - Semir Vranic
- Department of Basic Medical Science, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (I.G.); (S.V.); (H.A.-T.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
| | - Hamda Al-Thawadi
- Department of Basic Medical Science, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (I.G.); (S.V.); (H.A.-T.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
| | - Ala-Eddin Al Moustafa
- Department of Basic Medical Science, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (I.G.); (S.V.); (H.A.-T.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
- Biomedical Research Centre, QU Health, Qatar University, Doha 2713, Qatar
- Correspondence: ; Tel.: +974-4403-7817
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4
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Giulia Mantovani, Fragomeni SM, Inzani F, Fagotti A, Della Corte L, Gentileschi S, Tagliaferri L, Zannoni GF, Scambia G, Garganese G. Molecular pathways in vulvar squamous cell carcinoma: implications for target therapeutic strategies. J Cancer Res Clin Oncol 2020; 146:1647-1658. [PMID: 32335720 DOI: 10.1007/s00432-020-03226-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Additional prognostic factors and personalized therapeutic alternatives for vulvar squamous cell carcinoma (VSCC), especially for advanced stages with poor prognosis, are urgently needed. OBJECTIVES To review and assess literature regarding underlying molecular mechanisms of VSCC target therapeutic and prognostic approaches. METHODS We performed a narrative literature review from the inception of the database up to January 2020 limited to English language, organizing knowledge in five main fields: extracellular and intracellular cell cycle deregulation, tumor immune microenvironment, tumor angiogenesis and hormones. RESULTS EGFR immunohistochemical overexpression/gene amplification, representing early events in VSCC carcinogenesis, have been correlated with a worse prognosis and led to inclusion of erlotinib in cancer guidelines. p16 expression and HPV positivity are linked to a better prognosis, while p53 overexpression is linked to a worse prognosis; thus, biomarkers could help tailoring conventional treatment and follow-up. The implications of PD-L1 positivity in reference to HPV status and prognosis are still not clear, even though pembrolizumab is part of available systemic therapies. The role of tumor angiogenesis emerges through data on microvessel density, immunohistochemical VEGF staining and evaluation of serum VEGF concentrations. Few data exist on hormonal receptor expression, even though hormonal therapy showed great manageability. CONCLUSIONS We suggest adding p16, p53 and HPV status to routine hystopathological examination of vulvar biopsies or surgical specimens. Predictive biomarkers for anti-EGFR and anti-PD-1/PD-L1 drugs are needed. Enough preclinical data supporting anti-angiogenic target therapies in clinical trials are existing. Hormonal receptor expression deserves further investigation.
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Affiliation(s)
- Giulia Mantovani
- Dipartimento di Ginecologia e Ostetricia, Ginecologia Oncologica e Chirurgia Pelvica Mini-Invasiva, International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Simona Maria Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Frediano Inzani
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Fagotti
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Della Corte
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Scuola di Medicina e Chirurgia, Università degli studi di Napoli Federico II, Naples, Italy
| | - Stefano Gentileschi
- Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Garganese
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.,Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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5
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Dasgupta S, Ewing-Graham PC, Swagemakers SMA, van der Spek PJ, van Doorn HC, Noordhoek Hegt V, Koljenović S, van Kemenade FJ. Precursor lesions of vulvar squamous cell carcinoma - histology and biomarkers: A systematic review. Crit Rev Oncol Hematol 2020; 147:102866. [PMID: 32058913 DOI: 10.1016/j.critrevonc.2020.102866] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 12/01/2022] Open
Abstract
The precursor lesion of vulvar squamous cell carcinoma (VSCC), namely vulvar intraepithelial neoplasia (VIN), is classified as: human papillomavirus (HPV)-related high grade squamous intraepithelial lesion (HSIL), and HPV-independent differentiated VIN (dVIN). Traditionally, histology and immunohistochemistry (IHC) have been the basis of diagnosis and classification of VIN. HSIL shows conspicuous histological atypia, and positivity on p16-IHC, whereas dVIN shows less obvious histological atypia, and overexpression or null-pattern on p53-IHC. For both types of VIN, other diagnostic immunohistochemical markers have also been evaluated. Molecular characterization of VIN has been attempted in few recent studies, and novel genotypic subtypes of HPV-independent VSCC and VIN have been identified. This systematic review appraises the VSCC precursors identified so far, focusing on histology and biomarkers (immunohistochemical and molecular). To gain further insights into the carcinogenesis and to identify additional potential biomarkers, gene expression omnibus (GEO) datasets on VSCC were analyzed; the results are presented.
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Affiliation(s)
- Shatavisha Dasgupta
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | | | - Sigrid M A Swagemakers
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Vincent Noordhoek Hegt
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
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6
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Zhao S, Liu D, Shi W, Kang Y, Li Q, Liu Q, Chen M, Li F, Su J, Zhang Y, Wu L. Efficacy of a New Therapeutic Option for Vulvar Intraepithelial Neoplasia: Superficial Shaving Combined With Photodynamic Therapy. Lasers Surg Med 2019; 52:488-495. [DOI: 10.1002/lsm.23185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Shuang Zhao
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Dihui Liu
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Wei Shi
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Yanan Kang
- Department of Obstetrics and Gynecology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Qingling Li
- Department of Pathology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Queping Liu
- Department of Pathology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Mingliang Chen
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Fangfang Li
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Juan Su
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Gynecological Oncology Research and Engineering Center of Hunan ProvinceChangsha 410008 Hunan China
| | - Lisha Wu
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South University Changsha 410008 Hunan China
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7
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Watkins JC, Yang E, Crum CP, Herfs M, Gheit T, Tommasino M, Nucci MR. Classic Vulvar Intraepithelial Neoplasia With Superimposed Lichen Simplex Chronicus: A Unique Variant Mimicking Differentiated Vulvar Intraepithelial Neoplasia. Int J Gynecol Pathol 2019; 38:175-182. [PMID: 29750709 DOI: 10.1097/pgp.0000000000000509] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
High-grade vulvar intraepithelial neoplasia, a precursor lesion to vulvar squamous cell carcinoma, is subdivided into 2 types, classic or usual vulvar intraepithelial neoplasia (CVIN) and differentiated vulvar intraepithelial neoplasia (DVIN). CVIN, which is a human papilloma virus (HPV)-dependent lesion, is typically distinguished from DVIN, a p53 mutation-dependent process, by its distinct histomorphologic and immunohistochemical characteristics. However, distinguishing between the 2 entities becomes challenging in cases of CVIN with superimposed inflammatory changes, especially lichen simplex chronicus (LSC). Twelve cases of DVIN, 9 cases of LSC, and 9 cases of CVIN with superimposed LSC were assessed for a number of morphologic features, including hyperkeratosis, hypergranulosis, acanthosis, hypercellularity, abnormal maturation (i.e. abnormal keratinization close to the base and/or dyskeratosis), hyperchromasia, and basal atypia. Immunohistochemistry for p53, p16, and MIB-1 was performed for all cases. When sufficient tissue was available, HPV genotyping was performed for cases of CVIN with superimposed LSC. DVIN uniformly demonstrated abnormal maturation, and atypia involving the basal cell layer; they were all p16 negative and demonstrated p53 positivity of moderate to strong intensity in a basal and parabasal distribution. CVIN with superimposed LSC frequently displayed hyperchromasia involving the basal 3 to 4 cell layers, basal to full-thickness atypia, and apoptosis. CVIN with superimposed LSC demonstrated intense p16 positivity extending from the basal cells to the mid-epithelium and a reduction or loss of staining in maturing keratinocytes. P53 staining revealed a unique pattern of parabasal and mid-epithelial weak to moderate staining with sparing of the basal layer. Cases of LSC demonstrated heterogenous p53 positivity and were negative for p16. MIB-1 staining showed a similar range of positivity for all diagnoses. HPV genotyping revealed HPV 16 in all 5 cases of CVIN with LSC that underwent testing. We conclude that, although CVIN with superimposed LSC can closely resemble DVIN, morphologic features such as nuclear hyperchromasia uniformly involving the basal 3 to 4 cell layers, apoptosis, and absent or less pronounced cytoplasmic maturation are more suggestive of CVIN with superimposed LSC. In cases where the morphology remains ambiguous, immunohistochemistry for both p16 and p53 can be helpful. In particular, p53 parabasal and mid-epithelial staining without involvement of the basal layer appears to be a characteristic finding in CVIN with superimposed LSC. MIB-1 staining is of little utility in distinguishing between these entities and should not be routinely performed.
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Affiliation(s)
- Jaclyn C Watkins
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.C.W., C.P.C., M.R.N.) Stanford University Hospital, Palo Alto, California (E.Y.) Laboratory of Experimental Pathology, GIGA-Cancer, University of Liege, Liege, Belgium (M.H.) Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France (T.G., M.T.)
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8
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Takacs FZ, Radosa JC, Bochen F, Juhasz-Böss I, Solomayer EF, Bohle RM, Breitbach GP, Schick B, Linxweiler M. Sec62/Ki67 and p16/Ki67 dual-staining immunocytochemistry in vulvar cytology for the identification of vulvar intraepithelial neoplasia and vulvar cancer: a pilot study. Arch Gynecol Obstet 2019; 299:825-833. [PMID: 30607586 DOI: 10.1007/s00404-018-5021-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to analyze the diagnostic performance of a newly established immunocytochemical dual-staining protocol for the simultaneous expression of SEC62 and Ki67 in vulvar liquid-based cytology specimens for the identification of vulvar intraepithelial neoplasia (VIN) and vulvar cancer. In addition, we investigated the p16/Ki67 dual stain, which has already been established in cervical cytology. MATERIALS AND METHODS For this pilot study, residual material from liquid-based cytology was collected retrospectively from 45 women. The presence of one or more double-immunoreactive cells was considered as a positive test result for Sec62/Ki67 and p16/Ki67 dual staining. The test results were correlated with the course of histology. RESULTS All cases of VIN and vulvar cancer were Sec62/Ki67 and p16/Ki67 dual-stain positive, and normal and low-grade squamous intraepithelial lesions were all negative. The sensitivity of cytology for VIN + cases was 100% (22/22), whereas punch biopsy classified one case of vulvar carcinoma as inflammation. All cases with high-intensity (grades 3 and 4) Sec62 staining in Sec62/Ki67-positive cases were carcinomas. CONCLUSIONS The results of this study demonstrate that Sec62/Ki67 and p16 Ki67 dual-staining cytology could be a promising adjunctive diagnostic tool for VIN and squamous cell carcinoma, in addition to standard histology.
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Affiliation(s)
- Ferenc Zoltan Takacs
- Department of Obstetrics and Gynecology, University of Saarland, 66424, Homburg, Germany.
| | - Julia Caroline Radosa
- Department of Obstetrics and Gynecology, University of Saarland, 66424, Homburg, Germany
| | - Florian Bochen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Saarland, 66424, Homburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, University of Saarland, 66424, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Obstetrics and Gynecology, University of Saarland, 66424, Homburg, Germany
| | - Rainer M Bohle
- Department of General and Surgical Pathology, University of Saarland, 66424, Homburg, Germany
| | - Georg-Peter Breitbach
- Department of Obstetrics and Gynecology, University of Saarland, 66424, Homburg, Germany
| | - Bernard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Saarland, 66424, Homburg, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Saarland, 66424, Homburg, Germany
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9
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Swarts DRA, Voorham QJM, van Splunter AP, Wilting SM, Sie D, Pronk D, van Beurden M, Heideman DAM, Snijders PJF, Meijer CJLM, Steenbergen RDM, Bleeker MCG. Molecular heterogeneity in human papillomavirus-dependent and -independent vulvar carcinogenesis. Cancer Med 2018; 7:4542-4553. [PMID: 30030907 PMCID: PMC6144162 DOI: 10.1002/cam4.1633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 01/22/2023] Open
Abstract
Vulvar squamous cell carcinoma (VSCC) and precancerous vulvar intraepithelial neoplasia (VIN) can develop through human papillomavirus (HPV)-dependent and -independent pathways, indicating a heterogeneous disease. Only a minority of VIN progress, but current clinicopathological classifications are insufficient to predict the cancer risk. Here we analyzed copy number alterations (CNA) to assess the molecular heterogeneity of vulvar lesions in relation to HPV and cancer risk. HPV-status and CNA by means of whole-genome next-generation shallow-sequencing were assessed in VSCC and VIN. The latter included VIN of women with associated VSCC (VINVSCC ) and women who did not develop VSCC during follow-up (VINnoVSCC ). HPV-testing resulted in 41 HPV-positive (16 VINVSCC , 14 VINnoVSCC , and 11 VSCC) and 24 HPV-negative (11 VINVSCC and 13 VSCC) lesions. HPV-positive and -negative VSCC showed a partially overlapping pattern of recurrent CNA, including frequent gains of 3q and 8q. In contrast, amplification of 11q13/cyclinD1 was exclusively found in HPV-negative lesions. HPV-negative VINVSCC had less CNA than HPV-negative VSCC (P = .009), but shared chromosome 8 alterations. HPV-positive VINnoVSCC had less CNA than VINVSCC (P = .022). Interestingly, 1pq gain was detected in 81% of HPV-positive VINVSCC and only in 21% of VINnoVSCC (P = .001). In conclusion, HPV-dependent and -independent vulvar carcinogenesis is characterized by distinct CNA patterns at the VIN stage, while more comparable patterns are present at the cancer stage. Cancer risk in VIN seems to be reflected by the extent of CNA, in particular chromosome 1 gain in HPV-positive cases.
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Affiliation(s)
- Dorian R. A. Swarts
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Quirinus J. M. Voorham
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Quirinus J. M. Voorham,Stichting PALGAHoutenThe Netherlands
| | - Annina P. van Splunter
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Saskia M. Wilting
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Saskia M. Wilting,Department of Medical OncologyErasmus Medical CenterRotterdamThe Netherlands
| | - Daoud Sie
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Divera Pronk
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Divera Pronk,Hartwig Medical FoundationAmsterdamThe Netherlands
| | - Marc van Beurden
- Department of GynecologyAntoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Daniëlle A. M. Heideman
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Peter J. F. Snijders
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Chris J. L. M. Meijer
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Renske D. M. Steenbergen
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Maaike C. G. Bleeker
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
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Jeffreys M, Jeffus SK, Herfs M, Quick CM. Accentuated p53 staining in usual type vulvar dysplasia—A potential diagnostic pitfall. Pathol Res Pract 2018; 214:76-79. [DOI: 10.1016/j.prp.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022]
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11
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Saenz-Sardà X, Carrato C, Pérez-Roca L, Puig L, Ferrándiz C, Ariza A, Fernández-Figueras MT. Epithelial-to-mesenchymal transition contributes to invasion in squamous cell carcinomas originated from actinic keratosis through the differentiated pathway, whereas proliferation plays a more significant role in the classical pathway. J Eur Acad Dermatol Venereol 2017; 32:581-586. [DOI: 10.1111/jdv.14514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/25/2017] [Indexed: 12/14/2022]
Affiliation(s)
- X. Saenz-Sardà
- Division of Oncology and Pathology; Department of Clinical Sciences Lund; Lund University; Lund Sweden
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - C. Carrato
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Pérez-Roca
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Puig
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - C. Ferrándiz
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - A. Ariza
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M.-T. Fernández-Figueras
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari General de Catalunya-QuironSalud; Universitat Autònoma de Barcelona; Barcelona Spain
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12
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Biological relevance of human papillomaviruses in vulvar cancer. Mod Pathol 2017; 30:549-562. [PMID: 28059099 DOI: 10.1038/modpathol.2016.197] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 12/31/2022]
Abstract
The carcinogenic role of high-risk human papillomavirus (HR-HPV) types in the increasing subset of vulvar intraepithelial neoplasia and vulvar cancer in young women has been established. However, the actual number of vulvar cancer cases attributed to HPV is still imprecisely defined. In an attempt to provide a more precise definition of HPV-driven vulvar cancer, we performed HPV-type-specific E6*I mRNA analyses available for 20 HR-/possible HR (pHR)-HPV types, on tissue samples from 447 cases of vulvar cancer. HPV DNA genotyping was performed using SPF10-LiPA25 assay due to its high sensitivity in formalin-fixed paraffin-embedded tissues. Data on p16INK4a expression was available for comparative analysis via kappa statistics. The use of highly sensitive assays covering the detection of HPV mRNA in a broad spectrum of mucosal HPV types resulted in the detection of viral transcripts in 87% of HPV DNA+ vulvar cancers. Overall concordance between HPV mRNA+ and p16INK4a upregulation (strong, diffuse immunostaining in >25% of tumor cells) was 92% (K=0.625, 95% confidence interval (CI)=0.531-0.719). Among these cases, 83% were concordant pairs of HPV mRNA+ and p16INK4a+ and 9% were concordant pairs of HPV mRNA- and p16INK4a-. Our data confirm the biological role of HR-/pHR-HPV types in the great majority of HPV DNA+ vulvar cancers, resulting in an HPV-attributable fraction of at least 21% worldwide. Most HPV DNA+ vulvar cancers were associated with HPV16 (85%), but a causative role for other, less frequently occurring mucosal HPV types (HPV26, 66, 67, 68, 70 and 73) was also confirmed at the mRNA level for the first time. These findings should be taken into consideration for future screening options as HPV-associated vulvar preneoplastic lesions have increased in incidence in younger women and require different treatment than vulvar lesions that develop from rare autoimmune-related mechanisms in older women.
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Clancy A, Spaans J, Weberpals J. The forgotten woman's cancer: vulvar squamous cell carcinoma (VSCC) and a targeted approach to therapy. Ann Oncol 2016; 27:1696-705. [DOI: 10.1093/annonc/mdw242] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/08/2016] [Indexed: 01/22/2023] Open
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Hoang LN, Park KJ, Soslow RA, Murali R. Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathology 2016; 48:291-302. [PMID: 27113549 PMCID: PMC5518939 DOI: 10.1016/j.pathol.2016.02.015] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 01/11/2023]
Abstract
Growing evidence has established two major types of vulvar intraepithelial neoplasia (VIN), which correspond to two distinct oncogenic pathways to vulvar squamous cell carcinoma (VSCC). While the incidence of VSCC has remained relatively stable over the last three decades, the incidence of VIN has increased. VIN of usual type (uVIN) is human papillomavirus (HPV)-driven, affects younger women and is a multicentric disease. In contrast, VIN of differentiated type (dVIN) occurs in post-menopausal women and develops independent of HPV infection. dVIN often arises in a background of lichen sclerosus and chronic inflammatory dermatoses. Although isolated dVIN is significantly less common than uVIN, dVIN bears a greater risk for malignant transformation to VSCC and progresses over a shorter time interval. On histological examination, uVIN displays conspicuous architectural and cytological abnormalities, while the morphological features that characterise dVIN are much more subtle and raise a wide differential diagnosis. On the molecular level, dVIN is characterised by a higher number of somatic mutations, particularly in TP53. Here we review the classification, epidemiology, clinical features, histomorphology, ancillary markers and molecular genetics of both types of VIN, and discuss the morphological challenges faced by pathologists in interpreting these lesions.
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Affiliation(s)
- Lien N Hoang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Fascin expression in cervical normal squamous epithelium, cervical intraepithelial neoplasia, and superficially invasive (stage IA1) squamous carcinoma of the cervix. Pathology 2015; 46:433-8. [PMID: 24977742 DOI: 10.1097/pat.0000000000000124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aims of this study were to: investigate fascin expression in normal cervix, cervical intraepithelial neoplasia (CIN), and stage IA1 squamous cell carcinoma (SCC).Fascin immunostaining was performed in cervical biopsies showing normal squamous epithelium (n=10), CIN 1 (n=10), CIN 2-3 without invasion (n=11), and CIN 2-3 adjacent to SCC (n=40); SCC was also present in 27 of the latter cases.Fascin expression in normal squamous epithelium was restricted to basal and parabasal cells, whereas there was increased staining in immature squamous metaplasia and in most CIN lesions. Full thickness staining was more frequent in high grade CIN adjacent to invasion than in CIN 2-3 alone. Eighteen SCCs (67%) were fascin positive and seven cases showed accentuated staining at the tumour-stromal interface (invasive front). There was no consistent relationship between fascin expression in CIN lesions and in corresponding carcinomas. Fascin staining in reactive stromal cells sometimes made identification of the invasive neoplastic cells difficult.Fascin is overexpressed in most CIN lesions and this may be a marker of increased invasive potential in high grade CIN. However, fascin staining does not distinguish low and high grade CIN or in situ and invasive squamous neoplasia. Therefore fascin has limited diagnostic utility in demonstrating superficial stromal invasion.
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Stewart CJR, Bharat C, Leake R. Asynchronous glands in secretory pattern endometrium: clinical associations and immunohistological changes. Histopathology 2015; 67:39-47. [DOI: 10.1111/his.12620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/15/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Colin J R Stewart
- Department of Histopathology; King Edward Memorial Hospital; Perth WA Australia
- School for Women's and Infants’ Health; University of Western Australia; Perth WA Australia
| | - Chrianna Bharat
- Centre for Applied Statistics; University of Western Australia; Perth WA Australia
- Department of Research; Sir Charles Gairdner Hospital; Perth WA Australia
| | - Robyn Leake
- Hollywood Hospital; Nedlands Perth WA Australia
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