Gadkari Rasika, Ravi R, Bhatia Jasvinder Kaur
Department of Pathology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Pathology Laboratory, Nagpur, Maharashtra, India.
Cytojournal. 2022 Jun 14;19:39. doi: 10.25259/CMAS_03_14_2021. eCollection 2022.
Carcinoma of cervix is classified as per the WHO classification into primary tumors which are predominantly epithelial tumors, mesenchymal tumors and tumor like lesions, mixed epithelial stromal tumors, melanocytic, germ cell, and lymphoid tumors. Secondary tumors are uncommon. Squamous cell carcinoma (SCC) in various morphological forms needs to be separated from other epithelial tumors for treatment modality selection. Majority of SCC are human papilloma virus (HPV) positive. The histological pattern, HPV type, and grading do not affect prognosis. Mixed mesenchymal and epithelial tumors are of Mullerian origin. Among sarcomas, Botryoid rhabdomyosarcoma needs to be looked for, as a small biopsy may miss it. Carcinoma cervix is not the only cancer caused by HPV. High-risk HPV is implicated in causation of various other cancers such as anal cancers, oropharyngeal cancers, vulval cancers, vaginal cancers, and penile cancers. Low-risk HPV viruses similarly cause infections of perianal and genital region in males and females. The terminology for these lesions has evolved before understanding of pathogenesis of low- and high-risk HPV. The lower anogenital squamous terminology (LAST), an acronym for LAST, incorporates the low- and high-grade squamous intraepithelial lesion (HSIL) terminology. In invasive cancers, a superficially invasive SCC is a well-defined entity. LAST outlines areas where p16 use is recommended. No benefit of addition of other biomarkers like p63 or ki67 is found in problem-solving in differentiation of HSIL from mimics or low-grade squamous intraepithelial lesion. Routine use of biomarkers is not advocated.
子宫颈癌根据世界卫生组织的分类，分为原发性肿瘤，主要包括上皮性肿瘤、间叶性肿瘤和肿瘤样病变、混合性上皮间质肿瘤、黑素细胞性肿瘤、生殖细胞肿瘤和淋巴样肿瘤。继发性肿瘤并不常见。为了选择治疗方式，需要将各种形态学形式的鳞状细胞癌（SCC）与其他上皮性肿瘤区分开来。大多数SCC是人乳头瘤病毒（HPV）阳性。组织学模式、HPV类型和分级不影响预后。混合性间叶和上皮肿瘤起源于苗勒管。在肉瘤中，需要寻找葡萄状横纹肌肉瘤，因为小活检可能会遗漏它。子宫颈癌不是HPV引起的唯一癌症。高危HPV与其他各种癌症的发生有关，如肛门癌、口咽癌、外阴癌、阴道癌和阴茎癌。低危HPV病毒同样会引起男性和女性肛周和生殖器区域的感染。这些病变的术语在了解低危和高危HPV的发病机制之前就已经演变了。低位肛门生殖器鳞状上皮术语（LAST），LAST是其首字母缩写，纳入了低级别和高级别鳞状上皮内病变（HSIL）术语。在浸润性癌中，浅表浸润性SCC是一个明确的实体。LAST概述了推荐使用p16的区域。在解决HSIL与模仿病变或低级别鳞状上皮内病变的鉴别诊断问题时，未发现添加其他生物标志物如p63或ki67有任何益处。不提倡常规使用生物标志物。
