Int J Gynecol Pathol. 2022 Sep 1;41(5):447-458. doi: 10.1097/PGP.0000000000000839. Epub 2021 Dec 3.
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.
宫颈内膜腺癌（endocervical adenocarcinomas，ECAs）最近根据其与病因相关的形态学特征，按照国际宫颈内膜腺癌标准和分类（International Endocervical Adenocarcinoma Criteria and Classification，IECC）进行了重新分类，该系统被 2020 年世界卫生组织（World Health Organization，WHO）采用。该分类将 ECAs 分为人乳头瘤病毒（human papillomavirus，HPV）相关型（HPV-associated，HPVA）和 HPV 非相关型（HPV-independent，HPVI）。根据 2020 年 WHO 的分类，高危型（high risk，HR）HPV 相关性可通过腔面有丝分裂和凋亡的存在来组织学识别。因此，研究这种新分类形态学标准的可重复性对于观察肿瘤类型的可识别性非常重要。从土耳其 4 家机构收集了 94 例 ECAs 的全玻片，并根据 IECC/WHO 2020 标准以及 HR-HPV 的存在与否进行重新分类。通过 HPV DNA 原位杂交、p16 免疫组化以及在有冲突的病例中进行实时聚合酶链反应来确认 HR-HPV 的存在。最终诊断基于组织学评估和辅助检查结果的结合。我们的队列包括 73.4%的 HPVA 和 26.6%的 HPVI 病例。根据 2020 年 WHO 标准，92.7%的 HPVAs 和 88%的 HPVIs 很容易分类。HPV DNA 原位杂交在 91.3%的 HPVAs 中呈阳性，p16 在所有 HPVAs 中均呈阳性，在 8%的 HPVIs 中也呈阳性。总之，大多数 ECAs 可以根据 2020 年 WHO 标准的特征形态学特征进行诊断。然而，我们想强调的是，有丝分裂/凋亡标准在黏液性 ECAs 中可能没有帮助，在有挑战性的病例中应该使用 HR-HPV 的辅助检查。
