Introduction

HPV is identified in almost all squamous invasive cervical carcinomas and a high proportion of adenocarcinomas. HPV involvement in cervical adenocarcinoma is between 8.3% - 71.8% depending on the histological subtype. A new morphological classification of adenocarcinomas has been proposed where ADC are classified based on the presence or absence of HPV infection-related features (IECC, International Endocervical Adenocarcinoma Criteria and Classification, 2017). Two adenocarcinoma groups were established: HPV-associated (HPVA) and non-HPV associated (NHPVA).

The objective is to evaluate the reproducibility of IECC morphological criteria with a highly sensitive HPV testing in our own series of cervical adenocarcinomas.

Methods

We identified sixty-nine incident cases of endocervical adenocarcinoma identified through Tarragona and Girona cancer registries (Catalonia) between 1998-2007. All adenocarcinoma hematoxylin and eosin (HE) slides were reviewed by two expert pathologists and classified in accordance with the IECC system. HPV DNA was done using SPF-10 PCR/DEIA/LiPA25. Demographic and clinical information was retrieved from the cancer registry databases.

Results

The morphological diagnostic distribution was; HPVA (n=51): usual -type (56.5%), mucinous, not otherwise specified (10.1%); villoglandular (4.3%), mucinous, intestinal type (2.9%); NHPVA (n=18): clear cell adenocarcinoma (8.7%), gastric-type adenocarcinoma (7.2%), endometroid adenocarcinoma (5.8%), serous adenocarcinoma (2.9%) and mesonephric carcinoma (1.4%). The mean patient’s age in HPVA was 50.4, compared to 55.4 in NHPVA (p>0.05). HPV was identified in 68.6% of HPVA tumors and in 5.6% of NHPVA tumors (p<0.05). Tumor stage IV at diagnosis was 7.8% in HPVA and 16.7% in NHPVA (p>0.05). Finally, 27.5% of HPVA patients dead by cervical cancer compared to 33.3% of NHPVA (p>0.05).

Conclusions

Our results using IECC criteria with HE are supported by HPV detection results. The use of a specific immuno-marker p16, and HPV detection would help in complex diagnosis.