Clinical Outcomes of HPV-associated and Unassociated Endocervical Adenocarcinomas Categorized by the International Endocervical Adenocarcinoma Criteria and Classification (IECC)

Stolnicu, Simona; Hoang, Lien; Chiu, Derek S.; Hankó-Bauer, Orsolya; Terinte, Cristina; Pesci, Anna; Aviel‐Ronen, Sarit; Kiyokawa, Takako; Alvarado‐Cabrero, Isabel; Oliva, Esther; Park, Kay J.; Abu‐Rustum, Nadeem R.; Soslow, Robert A.

doi:10.1097/pas.0000000000001224

Cited by 102 publications

(119 citation statements)

References 14 publications

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“…Non‐HPV‐associated adenocarcinomas were larger, occurred in older patients and presented at a higher stage than HPVA ECAs. Subsequent studies have borne out the original findings, confirming that IECC is simple, practical and reproducible with improved interobserver agreement compared to WHO in classifying ECAs, and that this has important clinical applications with non‐HPV‐associated adenocarcinomas having significantly worse overall and disease‐free survival when compared to HPVA ECAs …”

Section: Classification Of Endocervical Adenocarcinomamentioning

confidence: 89%

Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification

Park

2019

Histopathology

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Cervical adenocarcinoma is a heterogenous group of tumours with various aetiologies, molecular drivers, morphologies, response to treatment and prognosis. It has become evident that human papillomavirus (HPV) infection does not drive all adenocarcinomas, and appropriate classification is critical for patient management, especially in the era of the HPV vaccine and HPV‐only screening. Identified as one of the most important developments in gynaecological pathology during the past 50 years, the separation of cervical adenocarcinomas into HPV‐associated (HPVA) and HPV‐independent has resulted in a transformation of the classification system for cervical adenocarcinomas. HPVA has been traditionally subclassified by morphology, such as usual type (UEA), mucinous and villoglandular, etc. However, it has become evident that cell type‐based histomorphological classification is not clinically meaningful, and the newly proposed International Endocervical Adenocarcinoma Criteria and Classification (IECC) is a necessary and relevant break from this prior system. Non‐HPV‐associated adenocarcinomas can be divided by their distinct morphology and molecular genomics with very different responses to standard therapies and potential for future targeted therapies. These include gastric‐type, clear‐cell, mesonephric and endometrioid adenocarcinomas. So‐called ‘serous’ carcinomas of the cervix probably represent morphological variants of UEA or drop metastases from uterine or adnexal serous carcinomas, and the existence of true cervical serous carcinomas is in question. This review will discuss the advances since WHO 2014, and how HPV status, pattern of invasion as described by Silva and colleagues, histological features and molecular markers can be used to refine diagnosis and prognostication for patients with cervical adenocarcinoma.

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Section: Classification Of Endocervical Adenocarcinomamentioning

confidence: 89%

Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification

Park

2019

Histopathology

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“…These have been the focus of an international collaboration formed to define a clinically meaningful categorization of EAC to supersede the previous morphology‐based WHO categories. This principally subdivides EAC into prognostically relevant and reproducible HPV‐associated (HPVA) and non‐HPV associated (non‐HPVA) histological types . The second proposal, also of prognostic importance, is to replace the conventional, poorly defined grading systems that have low reproducibility with a pattern‐based classification .…”

Section: Cervical Adenocarcinomas With Ovarian Metastases Simulating mentioning

confidence: 99%

“…This principally subdivides EAC into prognostically relevant and reproducible HPV-associated (HPVA) and non-HPV associated (non-HPVA) histological types. [99][100][101] The second proposal, also of prognostic importance, is to replace the conventional, poorly defined grading systems that have low reproducibility with a pattern-based classification. [102][103][104] This only applies to HPVA EAC, as all non-HPVA EAC fall into the poorest prognosis pattern C category.…”

Section: Cervical Adenocarcinomas With Ovarian Metastases Simulating mentioning

confidence: 99%

Metastases to the ovary arising from endometrial, cervical and fallopian tube cancer: recent advances

Casey

Singh

2019

Histopathology

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The introduction of genomic studies has enabled assessment of the clonality of synchronous tumours involving the ovary and other sites in the female genital tract in a definitive way. This has led to the abandonment of conventional approaches to primary site assignment, and the recognition that most such synchronous neoplasms are clonally related single tumours with metastatic spread, rather than independent primary tumours. These discoveries have implications for diagnostic practice, analogous to the gradual change over the last few decades in our approach to mucinous neoplasms of the ovary metastatic from the gastrointestinal tract. In this review, we first examine the routes of metastasis to the ovary, and then discuss the diagnostic and clinical implications of concurrent ovarian carcinomas arising in combination with endometrial, endocervical and tubal carcinomas. It is proposed that cases of primary low‐grade endometrioid endometrial carcinoma with a secondary unilateral ovarian tumour, both with indolent characteristics, may be classified as ‘FIGO stage IIIA‐simulating independent primary tumours’, with a comment that conservative management would be appropriate. It should be recognised that human papillomavirus‐associated endocervical adenocarcinomas may result in synchronous or metachronous ovarian metastases that appear to be unrelated to the primary tumour, and that these may be managed conservatively in the absence of other sites of disease. In cases of tubo‐ovarian high‐grade serous carcinoma, tubal intraepithelial or contralateral adnexal involvement should count as a pelvic disease site for staging purposes.

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“…Recently, attempts are being made to switch to a different endocervical adenocarcinoma classification that would more precisely reflect the different prognosis observed in the various subtypes. 10,11 Currently, misclassification is common. One of the proposals is the classification based on the morphologic features linked to HPV: HPV-associated (HPVA) and HPV-unassociated (NHPVA) features.…”

mentioning

confidence: 99%

“…The NHPVA includes such subtypes as endometrioid, gastric, minimal deviation, clear cell, serous and mesonephric tumors, and is related to a worse prognosis than that of the HPVA subtypes. 11 The pathogenesis of NHPVA subtypes is poorly understood. The minimal deviation and gastric subtypes may share the same precursor lesion, which is called lobular endocervical glandular hyperplasia, and some are associated with Peutz-Jeghers syndrome.…”

mentioning

confidence: 99%

‘Missing Adenocarcinomas’: Are They a Real Problem in Cervical Cancer Screening in Brazil?

Vale

Bragança

Zeferino

2019

Rev Bras Ginecol Obstet

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Clinical Outcomes of HPV-associated and Unassociated Endocervical Adenocarcinomas Categorized by the International Endocervical Adenocarcinoma Criteria and Classification (IECC)

Cited by 102 publications

References 14 publications

Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification

Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification

Metastases to the ovary arising from endometrial, cervical and fallopian tube cancer: recent advances

‘Missing Adenocarcinomas’: Are They a Real Problem in Cervical Cancer Screening in Brazil?

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