HPV Independent Cervical Cancer and Its Precursor Lesions TOG Jan 2023

Question 1

What’s the current epidemiology of cervical cancer

Answer 1

4th most frequently diagnosed cancer
4th leading cause of cancer mortality in women
604,000 new cases
342,000 deaths world wide 2020

Question 2

What are the subtypes of HPV independent adenocarcinoma

Answer 2

Gastric adenoca
Clear cell adenoca
Mesonephric adenoca
Not otherwise specified (NOS)

Question 3

What % of cervical cancers worldwide are HPV negative?

Answer 3

5-11%

Question 4

In presumed false negative HPV screening test, what second test can be used to rule in/out HPV initiated carcinogenesis?

Answer 4

E6/E7 mRNA with nuclei acid signal amplification

Question 5

What is the predominant non HPV associated mucinous carcinomas of the cervix

Answer 5

Gastric type

Question 6

What % of lobular endocervical glandular hyperplasia (LEGH) progress to Gastric adenoca

Answer 6

1.5%

Question 7

What the median age of presentation for HPV independent glandular adenoca(GAC)

Answer 7

49 years

Question 8

What’s the clinical presentation of GAC

Answer 8

Profuse Watery mucous vaginal discharge
AUB +- abdominal pain
Atypical glandular cells on cervical smear
Incidental histological finding on cervical loop excision or hysterectomy

Question 9

What are the examination findings of the cervix?

Answer 9

Bulky and undulated cervix without a well demarcated mass.
More likely to involve parametrium and vaginal tissues.

Question 10

What’s the distinguishing radiological feature of HPV associated GAC from non HPV associated cervical adenocarcinoma?

Answer 10

Non mass forming
Solid cystic pattern.
Deep stromal invasion and Indistinct borders on MRI

Question 11

How to differentiate GAC of primary cervical origin from a metastatic pancreatobilliary and non gynaecological mucinous adenoca.

Answer 11

PAX8 immunopositivity 68-80%

Question 12

What’s the usual surrogate marker of HPV associated cervical adenocarcinoma.

Answer 12

P16 positivity
Wild type P53 staining ( aberrant mutation type P53 staining in GAC)

Question 13

What’s the treatment for confirmed GAC?

Answer 13

Radical hysterectomy BSO and pelvic LAD or chemo radiation in advanced cases

Question 14

Which patients are at higher risk of LEGH and GAC?

Answer 14

Peutz-Jehgers syndrome

Question 15

What is the 5 year survival rate for GAC?

Answer 15

54%
Its 94% for HPV associated adenoca.

Question 16

What % of cervical cancers are clear cell adenoca

Answer 16

3-4%

Question 17

What is the known risk factor for CCadenoca?

Answer 17

In utero exposure to DES

Question 18

What % of cervical adenocarcinoma are mesonephric?

Answer 18

<1%

Question 19

What’s the clinical presentation of mesonephric adenocarcinoma of the cervix?

Answer 19

Abnormal vaginal bleeding
Abdominal pain
Uterine prolapse
Dyspareunia

Question 20

What is the immunohistochemistry picture in mesonephric type adenocarcinoma of the cervix

Answer 20

Wild type P53 immunostain positive
P16 and HPV negative

Question 21

What’s the incidence of HPV independent squamous cell carcinoma of the cervix

Answer 21

5-7%

Question 22

What is the distinguishing feature of HPV independent and HPV associated squamous cell cervical cancer?

Answer 22

More advanced stage at presentation
Higher LN mets
Reduced disease free interval and
Reduced overall survival
Scant evidence of precursor lesion