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LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 889

The paradigm shift in cervical adenocarcinoma


Depertment of Pathology, Apollo Hospitals, Hyderabad, Telangana, India

Date of Submission21-Oct-2020
Date of Decision01-Nov-2020
Date of Acceptance30-Nov-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Swarnalata Gowrishankar
Apollo Hospitals, Jubilee Hills, Hyderabad - 500 096, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_333_20

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How to cite this article:
Gowrishankar S. The paradigm shift in cervical adenocarcinoma. Cancer Res Stat Treat 2020;3:889

How to cite this URL:
Gowrishankar S. The paradigm shift in cervical adenocarcinoma. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 25];3:889. Available from: https://www.crstonline.com/text.asp?2020/3/4/889/305000



The article by Chauhan et al. titled “Cervical adenocarcinoma - A paradigm shift”[1] is interesting and highlights the advances in our approach to the pathologic classification of adenocarcinoma cervix, an advance which has still to appear in the WHO blue books, and which all pathologists need to be aware of. The current 2014 WHO classification lumps heterogeneous categories, which is not of value in clinical management.

The images in the report are however of poor resolution and the morphologic details mentioned cannot be clearly appreciated even on zooming into the images. Better-quality images would have certainly benefited the pathologist readers of the journal.

The seminal publication of the International Endocervical Adenocarcinoma Criteria and Classification in 2018 has stratified these tumors into HPV associated (HPVA) and non-HPV associated (NHPVA), similar to the new classifications of oropharyngeal and vulval carcinomas. This is important as the two groups differ significantly with respect to age, stage, and tumor size at presentation, with the HPVA tumors having a better prognosis.[2]

The case report also highlights the importance of morphology in the classification, with the HPVA group distinguished by easily identified apical mitotic figures and apoptosis identified at scanner magnification. The usual-type adenocarcinoma and the mucinous (including not otherwise specified) type, intestinal, signet ring, the invasive stratified mucin-producing intraepithelial lesion (SMILE), and the villoglandular type form the HPVA group, whereas the gastric type, clear cell, mesonephroid, and endometrioid form the NHPVA group. The gastric-type adenocarcinoma (NHPVA) is incidentally the second-most common and needs to be recognized for its aggressive behavior and poor prognosis.

The report mentions the concurrence of three different morphologies, namely usual, intestinal, and SMILE, all of which are HPV related, in the same lesion. As the images are suboptimal, this is not convincing. The entity SMILE as mentioned needs to be distinguished from squamous metaplasia and adenosquamous carcinoma.[3] A mucin stain would have highlighted the findings of multilayering with vacuolated mucin-containing cells and the absence of a lumina in the SMILE lesion in this case.

As high-risk HPV has a high prevalence in India,[4] it is possible that the incidence of adenocarcinoma of the cervix and particularly the HPVA phenotypes is more prevalent in our population, and we need to be aware of these pathologic entities, the immunohistochemical staining profile, and their mimics such as adenosquamous carcinoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chauhan K, Kathuria K. Cervical adenocarcinoma – A paradigm shift. Cancer Res Stat Treat 2020;3:590-3.  Back to cited text no. 1
  [Full text]  
2.
Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, et al. International Endocervical Adenocarcinoma Criteria and Classification (IECC): A new pathogenetic classification for invasive adenocarcinomas of the endocervix. Am J Surg Pathol 2018;42:214-26.  Back to cited text no. 2
    
3.
Park JJ, Sun D, Quade BJ, Flynn C, Sheets EE, Yang A, et al. Stratified mucinproducing intraepithelial lesions of the cervix: Adenosquamous or columnar cell neoplasia? Am J Surg Pathol 2000;24:1414-9.  Back to cited text no. 3
    
4.
Sena?pati R, Nayak B, Kar SK, Dwibedi B. HPV genotypes co-infections associated with cervical carcinoma: Special focus on phylogenetically related and non-vaccine targeted genotypes. PLoS One 2017;12:e0187844.  Back to cited text no. 4
    




 

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