Papillary Serous Carcinoma of the Cervix – Two Diseases with Distinct Clinico-Pathologic Profiles?
Akosua B Domfeh, Elisabetta Kuhn, Kay Park, Vinita Parkash. Yale University, New Haven, CT; Johns Hopkins School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Serous carcinoma of the cervix (SCx) is a rare variant of cervical adenocarcinoma with fewer than 50 cases reported. Original reports suggest a bimodal age distribution raising the possibility of separate etiopathogenesis. 13 additional cases are reported with clinico-pathologic details and TP53 mutational analysis.
Design: Clinicopathologic data were collected, immunohistochemistry (IHC) for p53, p16 and WT1and TP53 mutational analysis from exons 4 to 8 were performed where possible.
Results: Three women were below 50; all are alive and well up to 20 years after diagnosis. Two had a co-existent non-serous component. In one case where additional studies yielded results, the serous component was p53 positive and demonstrated HRHPV by ISH. 10 women were postmenopausal (ages 54 –70 yrs), of whom 3 are dead of disease with intraabdominal metastases and two are alive with intraabdominal disease. All of these cases had pure serous carcinoma. Tumor was p53 and p16 positive in all cases. In 9 of 10 cases, the tumor was also WT1 positive. In the 5 relatively recent cases where the fallopian tubes were examined by the SEE-FIM protocol, serous tubal intraepithelial carcinoma (STIC) was identified. 2 of 3 cases demonstrated identical TP53 missense mutations at both sites. The last case was WT1 negative at both sites, and TP53 mutation was not detected.
Conclusions: So-called SCx may represent two distinct diseases. In young patients, SCx represents a vanishingly rare variant of cervical adenocarcinoma which does not necessarily have the often poor prognosis of traditional serous carcinomas. At least in some cases, it is HPV related. In older patients, at least some cases represent metastatic serous carcinoma from an occult tubal primary. These findings underscore the importance of using the SEE-FIM protocol for the examination of fallopian tubes in cases of possible cervical serous carcinomas.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 232, Tuesday Afternoon