Introduction/Background Cervical cancer is one of the leading causes of cancer in women worldwide. Histologically, the majority of cases are squamous cell carcinoma, although incidence of adenocarcinoma is increasing, representing approximately 25% of all cases. There is evidence suggesting that adenocarcinomas have a worse prognosis, so it has been proposed to establish criteria to improve the current risk stratification. Silva has proposed using a system that takes into account destructive stromal invasion, lymphovascular space involvement and grade of cytological atypia to determine prognosis.
Methodology Patients with diagnosis of cervical adenocarcinoma or adenocarcinoma in situ at Hospital Santa Cristina in Madrid, Spain, from 1990 to 2021, were collected. 63 cases were reviewed and reclassified according to WHO 2018 classification, applying Silva patterns for infiltrative HPV- related tumors. Data of previous PAP-test and HPV-test, presence of lymphovascular space involvement, lymph node disease, status of surgical margins, p16, hormonal receptors or coexistence of dysplasia or squamous cancer were collected. Other factors such as age, previous parity, type of treatment, recurrence and survival were also considered.
Results 63 patients were collected, and subdivided into 6 in situ adenocarcinoma and 57 infiltrative adenocarcinoma. 6 cases were not HPV- related and 22 are known to be HPV- related; the remaining 35 cases needed to be reclassified based on p16, since HPV was not initially tested. 32% of the HPV- related cases presented pattern A of Silva, 12% pattern B and 56% pattern C. Mean age of the patients was 52 years old. Treatment modalities were surgery or chemo-radiation. 9 patients presented disease progression and died of disease.
Conclusion Classification for cervical adenocarcinoma is no longer based on morphology alone. Subclassification of infiltrative HPV-related adenocarcinoma considering Silva patterns offer prognostic factors that may enable to establish the risk of disease recurrence, and therefore, extension of treatment.
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