Primary Squamous Cell Carcinoma of the Vagina: HPV Detection, p16 Immunostaining and Clinicopathological Correlations
J Ordi, V Fuste, M del Pino, I Alonso, A Garcia, A Perez, A Torne, J Pahisa. Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; Hospital Vall d'Hebron, Barcelona, Spain
Background: Primary squamous cell carcinoma of the vagina (SCCVa) is rare. Human papillomavirus (HPV) has been implicated in its pathogenesis in a percentage of cases. Nevertheless, there is scant information on the role of HPV in SCCVa, and the clinico-pathological significance of HPV involvement in this tumor has not been clearly defined.
Design: All cases of SCCVa diagnosed between 1995 and August 2008, were retrieved from the surgical pathology files of two Hospitals from Barcelona. The clinical charts and the pathological materials were reviewed. Patients with a previous history of carcinoma of the uterine cervix diagnosed less than 5 years before were excluded from the study. HPV was detected and typed by PCR using the SPF10 primers In all cases immunohistochemical staining for p16 and p53 was performed.
Results: We retrieved 32 cases of SCCVa. HPV was detected in 25 cases (78.1%). HPV 16 was the most prevalent type identified (18 out of 25 [72.0%] HPV-positive cases). Patients with HPV-positive tumors were significantly younger than patients with HPV-negative neoplasms (62.6±13.8 vs. 74.0±8.5; p=0.049). A previous history of carcinoma or intraepithelial neoplasia of the uterine cervix or vulva diagnosed more than 5 years before the diagnosis of SCCVa was identified in 56.0% (14/25) of women with HPV-positive tumors and none of HPV-negative tumors (p=0.01). The upper third of the vagina was exclusively involved in 8/25 (32%) HPV-positive and 0/7 (0%) HPV-negative tumors (p=0.14). Histologically, 21/25 (84%) HPV-positive tumors and 1/7 (14.3%) of HPV-negative tumors were non-keratinizing, basaloid or warty, whereas 4/25 (16%) and 6/7 (85.7%) were of keratinizing type (p=0.006). Diffuse staining for p16 was observed in 24/25 (96%) of HPV-positive and 1/7 (14.3%) of HPV-negative tumors (p<0.001). Positive staining for p53 was observed in 12.0% HPV-positive and 57.1% HPV-negative tumors (p=0.02).
Conclusions: 1) A high proportion of SCCVa are related to HPV infection; (2) Immunostaining for p16 may be helpful in the identification of tumors associated with HPV infection; and (3) HPV-positive tumors tend to affect younger women with previous history of carcinoma of the uterine cervix and to involve more frequently the upper third of the vagina.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 138, Tuesday Afternoon