This content is part of a paid partnership with Australian Clinicallabs.
At a recent Clinical Labs Colposcopy Case Review meeting, four of the 15 cases discussed had significant glandular (endocervical) abnormalities including adenocarcinoma in situ (AIS) and one patient with invasive adenocarcinoma of the cervix.
Case Study: Invasive Endocervical Adenocarcinoma
Clinical Director of Anatomical Pathology
Dr Jenny Grew began pathology training at Christchurch Hospital (NZ), gaining fellowship of the Royal College of Pathologists in 2001. In 2007 she moved to Queensland as head pathologist at QML Pathology. In 2017, Jenny moved to WA and joined Australian Clinical Labs WA as Clinical Director of Anatomical Pathology. She is a keen educator, providing sessions for general practitioners on a range of pathology topics. She is a champion of multi-disciplinary patient care in private pathology and has founded and helped lead several clinico-pathology review meetings in a variety of settings, including private gastroenterology, colposcopy, breast cancer, general surgery, radiology and oncology.
KC is a 30-year-old woman on the oral contraceptive pill presented with intermenstrual and post-coital bleeding. The referral cervical screen test was HPV 16 positive and the cytology was negative. At colposcopy, KC had a type 1 transformation zone, and the impression was of a high-grade squamous lesion. Repeat cytology at colposcopy was negative and a colposcopic biopsy provided a scant sample of mucus and benign endocervical epithelium.
Because of discordance with the colposcopic appearances, a cytology sample was repeated two months later, this time showing features of a possible high-grade endocervical glandular lesion (see Figure 1). The patient underwent a cold-knife cone biopsy which showed widespread involvement of the cervix by invasive adenocarcinoma of usual endocervical type (see Figure 2). The tumour showed diffuse strong, block-type p16 immunohistochemical staining (see Figure 3), indicating the presence of an integrated high-risk HPV type.
The tumour extended to the deep endocervical and nine o’clock margins. The patient’s case is to be referred for discussion at the KEMH Gynaecological Oncology Tumour teleconference (TCON) for management planning, which surgically is expected to be a radical ovary-sparing hysterectomy.
Screening for Glandular Abnormalities of the Cervix
Just as with squamous cancers of the cervix, the majority of endocervical adenocarcinomas are related to oncogenic HPV types 16 and 18.
Most cervical cancers are squamous whilst about 25% are adenocarcinoma. After an initial decrease, the cervical screening program in Australia had little impact on reducing the incidence of adenocarcinoma.
Reasons for this include the difficulty seeing and sampling glandular lesions, and interpretation issues in cytology samples. Since endocervical adenocarcinoma is an HPV-related cancer, primary HPV screening enables earlier detection and is more effective than cytology in preventing this cancer.
Eliminating cervical cancer by 2035
Cancer Council data suggests that Australia is set to become the first country in the world to eliminate cervical cancer, provided vaccination and screening coverage are maintained at their current levels.
By 2022, it is predicted that there will be fewer than six cervical cancer cases in 100,000 women, falling into the category of a ‘rare cancer’. That rate is predicted to drop below four cases in 100, 000 by 2035.
The challenge remains to extend these successes to populations still vulnerable to HPV-related diseases, including indigenous communities and low- and middle-income countries.
Clinical Labs WA proudly coordinates regular Colposcopy Case Review Meetings to encourage best practice for clinical case review and patient management.
Hosted our Clinical Director of Anatomical Pathology, Dr Jenny Grew, meeting attendance is via video conference and CPD points are available.
If you are a clinician performing colposcopy and would like to be involved, please contact Amanda Reynolds on 0428 921 023 or amanda.reynolds@clinicallabs.com.au
Questions? Contact the editor.
Disclaimer: Please note, this website is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional’s advice. Opinions expressed at this website do not necessarily reflect those of Medical Forum magazine. Medical Forum makes no warranties about any of the content of this website, nor any representations or undertakings about any content of any other website referred to, or accessible, through this website