Cervical HPV Pathology Reports: Key Insights and Questions

Please inquire about the cervical HPV pathology report issues?

Hello Dr.
Huang, I had a normal Pap smear in January of this year, but the self-paid HPV Roche (Cobas) DNA test showed a positive result for high-risk HPV type 16.
Subsequently, a biopsy was performed for pathological examination, and the report is as follows: Clinical diagnosis: HPV DNA(+) type 16; R/O CIN 1.
Pathological diagnosis report: Diagnosis: Cervix uteri, punch biopsy, showing adenocarcinoma in situ.
Microscopy: The cervical biopsy shows dysplastic cells in the transformation zone, either in a compact, sheet-like arrangement along the surface epithelium or confined to the glands with focal cribriforming in a normal lobular pattern.
The dysplastic cells are characterized by a high nuclear-to-cytoplasmic (N/C) ratio, pleomorphic and hyperchromatic nuclei, crowding but loss of polarity, and mitotic figures.
The immunostain of P40 shows negative staining of the dysplastic cells in a sheet-like arrangement, indicating no squamous cell differentiation.
After reviewing the pathology report, the clinic physician stated that I have cervical adenocarcinoma in situ and referred me to a major hospital for a cervical conization procedure.
After the excision, the tissue was sent for pathological examination again, and the pathology report is as follows: Uterus, cervix, LEEP, adenocarcinoma in situ (AIS).
Uterus, endocervix, curettage, suboptimal specimen.
The specimen is submitted in two separate bottles labeled as A: LEEP and B: endocervical curettage, respectively, fixed in formalin.
Specimen labeled as A consists of one tissue fragment measuring 3.1 x 1.4 x 1.4 cm.
Grossly, it is tan, white, and elastic.
Specimen B consists of tiny aggregated tissue fragments measuring 0.1 x 0.1 x 0.1 cm.
Grossly, they are yellowish-white and soft.
All sections are labeled as: Jar 0A1-6: LEEP and B: endocervical curettage.
Microscopy: The sections A1-6 reveal cervical tissue fragments with focal cauterizing artifacts, showing atypical glandular structures.
Occasional presence of mitosis or nucleoli can also be noted.
No evident foci of stromal invasion can be seen in these sections.
Immunohistochemically, these cells are positive for p16 but negative for ER.
Adenocarcinoma in situ (AIS).
The section margin is close.
The section B shows blood clot and a few cervical epithelial cells.
It is inadequate for evaluation.

I apologize for the numerous questions, but since my attending physician did not explain thoroughly, I would appreciate your clarification on the following issues:
1.
Since I tested positive for high-risk HPV type 16 and the first biopsy pathology report indicates AIS, does this mean that even if I am classified as CIN 1, I need to urgently proceed with LEEP conization rather than just follow-up observation?
2.
In the second pathology report, the immunohistochemical staining shows p16(+) and ER(-), indicating that I have endocervical adenocarcinoma rather than endometrial endometrioid adenocarcinoma, correct?
3.
If the answer to question 2 is correct, it confirms that the information I found online is accurate, which states that p16, ER, vimentin, and CEA are used to differentiate between endocervical adenocarcinoma and endometrial endometrioid adenocarcinoma.
In the first pathology report, the immunostaining result for P40 is negative; is this to differentiate between which two types of lesions or cancers?
4.
In the second pathology report, the last sentence regarding specimen A states, "The section margin is close." What does this mean? Does it indicate that the lesion is at the edge of the excised conization, suggesting that the excision may not have been adequate?
5.
In the second pathology report, specimen B is a curettage sample from the endocervix, but due to suboptimal sampling, it cannot be evaluated, meaning we cannot determine if HPV has infected my endometrium, correct?
I apologize for the many questions, and I appreciate your efforts in answering the public's inquiries after a long day of work.
Thank you!

Xiao Yu, 30~39 year old female. Ask Date: 2017/04/04

Dr. Huang Jianzhong reply Obstetrics and Gynecology

It is the responsibility of the attending physician to provide a detailed explanation, while it is the patient's right to request such an explanation.

Reply Date: 2017/04/04

More Info

Understanding cervical HPV pathology reports can be complex, especially when dealing with high-risk HPV types and the potential for cervical cancer. Based on your detailed pathology reports and the questions you've raised, let's break down the key points and provide clarity on your situation.

1. High-Risk HPV and Immediate Action: The presence of high-risk HPV type 16 is significant because it is strongly associated with the development of cervical cancer. Even if your initial Pap smear indicated CIN 1 (which is a mild dysplasia), the finding of adenocarcinoma in situ (AIS) in your biopsy indicates a more serious condition. AIS is a pre-invasive form of cancer, meaning that while it has not invaded deeper tissues, it has the potential to progress to invasive cancer if not treated. Given these findings, your physician's recommendation for a LEEP (Loop Electrosurgical Excision Procedure) was appropriate and necessary. This procedure allows for both diagnosis and treatment, removing the affected tissue to prevent progression.

2. Immunohistochemical Findings: The second pathology report indicates that the immunohistochemical staining showed positive p16 and negative estrogen receptor (ER). The positive p16 is a marker often associated with HPV-related lesions, confirming the presence of HPV-related adenocarcinoma in situ. This finding suggests that you have endocervical adenocarcinoma rather than endometrial endometrioid adenocarcinoma, which is a different type of cancer that arises from the lining of the uterus. Your understanding is correct; p16, ER, vimentin, and CEA are indeed used to differentiate between these types of cancers.

3. Role of P40 Staining: The negative P40 staining in your first report is relevant for distinguishing between squamous cell carcinoma and adenocarcinoma. P40 is a marker for squamous differentiation, and its absence suggests that the dysplastic cells are not of squamous origin, which aligns with the diagnosis of adenocarcinoma in situ.

4. Close Section Margin: The phrase "the section margin is close" in your second report indicates that the edges of the tissue that was removed are near the area where abnormal cells were found. This could imply that not all of the potentially affected tissue was removed, which may necessitate further treatment or monitoring. It is crucial to discuss this finding with your healthcare provider to understand the implications for your treatment plan.

5. Inadequate Specimen for Evaluation: The second specimen labeled B, which was noted as inadequate for evaluation, means that the sample taken was too small or not representative enough to provide a clear diagnosis. This does not directly indicate whether HPV has infected the endometrium (the lining of the uterus), but it does mean that further testing may be required to assess the situation fully.

In summary, your case involves significant findings that warrant careful monitoring and treatment. The presence of high-risk HPV, along with the diagnosis of adenocarcinoma in situ, indicates that you should follow your physician's recommendations closely. Regular follow-ups, including Pap smears and possibly additional imaging or biopsies, will be essential in managing your health moving forward. Always feel empowered to ask your healthcare provider for clarification on any findings or recommendations, as understanding your health is crucial in making informed decisions about your care.

Similar Q&A

Understanding Cervical Biopsy Results: Immunohistochemical Staining Insights

Hello Dr. Tsao: A few days ago, I consulted with a physician regarding my cervical biopsy report. At the bottom of the issue, I thanked Dr. Tsao for the response. Today, I saw a pathology report on the National Health Insurance Easy Access platform, and I am unclear about its rel...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, just continue with regular follow-ups in obstetrics and gynecology. Wishing you good health.

Understanding Vulvar Papilloma: Insights from Biopsy Reports

Due to the presence of a papillomatous lesion on the vulva, the doctor was unable to make a visual diagnosis and requested a biopsy. The report is as follows, and I would like to ask: 1. Does this report rule out the possibility of the papillomatous lesion being a condyloma acum...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, this is the pathology report. The descriptions may vary slightly between hospitals, so it is recommended that you consult with a pathologist. Wishing you good health.

Understanding Cervical Specimen Quality and Its Impact on HPV Testing

Hello Director Zhang, I recently received the report for the liquid-based cytology test. The quality of the specimen was only acceptable (reason: absence of endocervical components), and there was inflammation within the normal range. I would like to ask you: 1. In the absence of...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, based on your brief description, if the report does not recommend a repeat Pap smear, then follow the physician's suggested treatment and regular check-ups. It is best to discuss the relevant recommendations with the examining physician based on the complete report of...

Understanding Cervical Cone Biopsy: Dysplasia, Cancer Risks, and Recurrence Rates

Hello Doctor: My cervical biopsy report indicates Uterus, cervix, biopsy - Moderate dysplasia. The doctor recommended that I undergo a cervical conization procedure (which I have already done). 1. Can you tell me if my pathology report is considered cervical cancer or a precancer...

Dr. Chen Changfu reply Obstetrics and Gynecology
Dear online friend: Hello! Your cervical biopsy report indicates "Uterus.cervix, biopsy - Moderate dysplasia," which is a precancerous condition and not yet cervical cancer. Since precancerous lesions for cervical cancer take a long time to develop, early detection allo...