Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Romania, Targu Mures, Romania.
Department of Pathology and Laboratory Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
Virchows Arch. 2019 Nov;475(5):537-549. doi: 10.1007/s00428-019-02601-0. Epub 2019 Jun 17.
Endocervical adenocarcinomas (ECAs) are currently classified according to the 2014 World Health Organization (WHO) system, which is predominantly based on descriptive morphologic characteristics, considers factors bearing minimal etiological, clinical, or therapeutic relevance, and lacks sufficient reproducibility. The 2017 International Endocervical Adenocarcinoma Criteria and Classification (IECC) system was developed by a group of international collaborators to address these limitations. The IECC system separates ECAs into two major groups-those that are human papillomavirus-associated (HPVA) and those that are non-HPV-associated (NHPVA)-based on morphology (linked to etiology) alone, precluding the need for an expensive panel of immunohistochemical markers for most cases. The major types of HPVA ECA include the usual (with villoglandular and micropapillary architectural variants) and mucinous types (not otherwise specified [NOS], intestinal, signet-ring, and invasive stratified mucin-producing carcinoma). Invasive adenocarcinoma NOS is morphologically uninformative, yet considered part of this group when HPV positive. NHPVA ECAs include gastric, clear cell, endometrioid, and mesonephric types. The IECC system is supported by demographic and clinical features (HPVA ECAs develop in younger patients, are smaller, and are diagnosed at an earlier stage), p16/HPV status (almost all HPVA ECAs are p16 and/or HPV positive), prognostic parameters (NHPVA ECAs more often have lymphovascular invasion, lymph node metastases, and are Silva pattern C), and survival data (NHPVA ECAs are associated with worse survival). A move from the morphology-based WHO system to the IECC system will likely provide clinicians with an improved means to diagnose and classify ECAs, and ultimately, to better personalize treatment for these patients.
宫颈内膜腺癌（endocervical adenocarcinomas，ECAs）目前根据 2014 年世界卫生组织（World Health Organization，WHO）系统进行分类，该系统主要基于描述性形态特征，考虑到与病因学、临床或治疗相关性最小的因素，且缺乏足够的重现性。2017 年国际宫颈内膜腺癌标准和分类（International Endocervical Adenocarcinoma Criteria and Classification，IECC）系统由一组国际合作者开发，旨在解决这些局限性。该系统基于形态学（与病因学相关）将 ECAs 分为两大类——人乳头瘤病毒相关（human papillomavirus-associated，HPVA）和非 HPV 相关（non-HPV-associated，NHPVA），而无需对大多数病例进行昂贵的免疫组织化学标志物检测。主要的 HPVA ECA 类型包括常见型（伴有绒毛状和微乳头状结构变体）和黏液型（非特指型、肠型、印戒细胞型和侵袭性柱状黏液腺癌）。非特指型浸润性腺癌形态学上无特征，但 HPV 阳性时被认为属于这一组。NHPVA ECAs 包括胃型、透明细胞型、子宫内膜样型和中肾管型。IECC 系统得到了人口统计学和临床特征（HPVA ECAs 发生在年轻患者中，体积较小，诊断较早）、p16/HPV 状态（几乎所有 HPVA ECAs 均为 p16 和/或 HPV 阳性）、预后参数（NHPVA ECAs 更常发生血管淋巴管侵犯、淋巴结转移和 Silva 模式 C）和生存数据（NHPVA ECAs 与较差的生存相关）的支持。从基于形态学的 WHO 系统向 IECC 系统的转变可能为临床医生提供一种更好的方法来诊断和分类 ECAs，并最终为这些患者提供更好的个体化治疗。
