Lower Female Genital Tract Tumors With Adenoid Cystic Differentiation

Abstract

Lower female genital tract tumors with adenoid cystic differentiation are rare, and data on their relationship with high-risk human papillomavirus (HPV) are limited. Here we report the clinicopathologic features from a case series. Tumors with adenoid cystic differentiation, either pure or as part of a carcinoma with mixed differentiation, arising in the lower female genital tract were evaluated by means of immunohistochemical analysis for p16 expression and in situ hybridization using 1 or more probes for high-risk HPV (a high-risk probe covering multiple types, a wide-spectrum probe, and separate type-specific probes for HPV16 and HPV18) and when possible by polymerase chain reaction for high-risk HPV. Six cervical carcinomas with adenoid cystic differentiation admixed with various combinations of at least 1 other pattern of differentiation, including adenoid basal tumor (epithelioma and/or carcinoma), squamous cell carcinoma (basaloid or keratinizing), and small cell carcinoma were identified in patients ranging in age from 50 to 86 years (mean, 73 y; median, 76 y). All of these tumors were characterized by diffuse p16 expression. High-risk HPV was detected in 5 of 6 tested cases: 4 cases by in situ hybridization (all positive for HPV-wide-spectrum and HPV16) and 1 by polymerase chain reaction (HPV45). Seven pure adenoid cystic carcinomas (6 vulvar and 1 cervical) were identified in patients ranging in age from 27 to 74 years (mean, 48 y; median, 48 y). All of these tumors were characterized by variable p16 expression ranging from very limited to more extensive but never diffuse. No high-risk HPV was detected in any of these pure tumors. Lower female genital tract carcinomas with adenoid cystic differentiation appear to comprise 2 pathogenetically distinct groups. Cervical carcinomas with mixed differentiation, including adenoid cystic, adenoid basal, squamous, and small cell components, are etiologically related to high-risk HPV and can be identified by diffuse p16 expression. Pure vulvar and cervical adenoid cystic carcinomas appear to be unrelated to high-risk HPV and are distinguished from the mixed carcinomas by nondiffuse p16 expression.

Lineage-Specific Alterations in Gynecologic Neoplasms with Choriocarcinomatous Differentiation: Implications for Origin and Therapeutics

“…IHC staining was performed on formalin-fixed, paraffinembedded tissue sections, using Ventana Benchmark automation and the Ultra View detection kit (Ventana Medical Systems) as previously described (27). Markers used included Cyclin D1 (SP4, Cell Marque; prediluted), ER (SP-1, Ventana; prediluted), Gata3 (L50-823, Biocare; 1:100 dilution), hCG (mouse polyclonal, Ventana; prediluted), Her2 (4B5, Ventana; prediluted), HSD3B1 (3C11-D4, Novus Biologicals; 1:2,000 dilution), Napsin A (IP64, Leica; prediluted), p53 (BP53-11, Ventana; prediluted), Pax8 (Rabbit polyclonal, Proteintech Group; 1:800 dilute), PD-L1 (SP263, Ventana; prediluted), PR (1E2, Leica; prediluted).…”

A clinicopathological and molecular analysis of cervical carcinomas with basaloid features

“…Hence, we believe that the ACC-like components in mixed carcinomas represent the morphological mimics of salivary ACCs. Xing et al 4 suggested the presence of two distinct ACC groups of vulvar and cervical origin: HR-HPV-related mixed carcinomas with some adenoid cystic differentiations and HR-HPV-unrelated pure adenoid cystic carcinomas. The HR-HPV-related mixed carcinomas in that study are similar to our cases, although the details of immunophenotype and gene fusions were not investigated.…”

Human Papillomavirus–Related Carcinoma With Adenoid Cystic–like Features of the Sinonasal Tract (Also Known as Human Papillomavirus–Related Multiphenotypic Sinonasal Carcinoma)

“…6 Although some tumors with adenoid cystic differentiation in the genitourinary or gynecologic system have been reported previously, the definite association with HPV infection remains unclear. [13][14][15] In a case series published in 2016, 16 lower female genital tract tumors with adenoid cystic differentiation could be subdivided into 2 groups: carcinoma with mixed differentiation including the adenoid cystic component, and pure adenoid cystic carcinoma. The former shows diffuse p16 expression and is related to high-risk HPV, and the latter shows the opposite results, which indicates that they may be 2 distinct entities.…”