Clear cell adenosquamous carcinoma of the cervix. An aggressive tumor associated with human papillomavirus-18.

BACKGROUND

It is well recognized that adenocarcinomas and adenosquamous carcinomas of the cervix are frequently associated with human papillomavirus (HPV)-16 or -18. However, few studies have investigated associations between histologic variants of these tumors and specific types of HPV.

METHODS

Eleven cases of cervical adenosquamous carcinoma with an unusual histologic appearance were characterized using histochemical and immunohistochemical stains. Sections were tested for the presence of HPV DNA using the polymerase chain reaction (PCR) and type specific primers for HPV-16 and -18. Clinical outcome was determined from a chart review.

RESULTS

All tumors were histologically characterized by the presence of sheets of cohesive cells with prominent cell borders and a vacuolated or clear cytoplasm containing large amounts of glycogen. All tumors had focal gland formation and stained positive with mucicarmine stain. Using PCR, HPV-18 DNA was identified in all cases. The youngest patient was 24 years old and the oldest 74 years (mean, 43 years). Eight (73%) of the 11 patients have developed recurrent disease with a mean follow-up until recurrence of 9.5 months (range, 3-22 months). Seven (64%) of the 11 patients have died of their cervical tumors. Of the five patients with Stage IB disease, three (60%) have died of their cervical tumors.

CONCLUSIONS

A subset of invasive cervical adenosquamous carcinoma associated with HPV-18 that has a distinctive histologic appearance and an aggressive clinical course is described. The term "clear cell adenosquamous carcinoma" is proposed for this unique variant of invasive cervical carcinoma.