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HPV-Associated Cervical Neoplasia

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Practical Gynecologic Pathology

Part of the book series: Practical Anatomic Pathology ((PAP))

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Abstract

This chapter addresses common benign changes in the cervix as well as in situ and invasive lesions associated with human papillomavirus (HPV). Metaplastic changes of both the squamous and columnar epithelium of the cervix are very common, including transitional cell metaplasia and tubal/tubo-endometrioid metaplasia. Additionally, various hyperplastic glandular proliferations may be seen, such as microglandular hyperplasia and lobular endocervical glandular hyperplasia. Cervical inflammation from various etiologies is extremely common and associated with characteristic reactive epithelial changes. Various alterations are also seen in women who are pregnant or taking exogenous hormones, for example, stromal decidualization and Arias-Stella reaction. While most of these benign findings are usually readily recognized as such, careful morphologic assessment and application of immunohistochemistry may be necessary for distinction from the preneoplastic and neoplastic entities which they may mimic. HPV-related squamous intraepithelial lesions of the cervix have undergone many changes in terminology, and are now classified as low grade (LSIL) and high grade (HSIL). HPV-related glandular intraepithelial neoplasia is termed adenocarcinoma in situ, and variations such as intestinal differentiation may be seen. Diagnosis of these lesions and distinction from benign mimics is aided by ancillary studies. Invasive HPV-related carcinomas include many subtypes of squamous cell carcinoma and adenocarcinoma. Classification systems, diagnostic criteria, and important pitfalls for all of these entities are provided. Additionally, the role of cytologic–histologic correlation and new management guidelines are briefly discussed.

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Abbreviations

AGC:

atypical glandular cells

AIS:

adenocarcinoma in situ

ASCCP:

American Society for Colposcopy and Cervical Pathology

ASC-H:

atypical squamous cells, cannot exclude HSIL

ASCUS:

atypical squamous cells of undetermined significance

CAP:

College of American Pathologists

CHC:

cytologic–histologic correlation

CIN:

cervical intraepithelial neoplasia

CK:

cytokeratin

CLIA:

Clinical Laboratory Improvement Amendments of 1988

DLEGH:

diffuse laminar endocervical glandular hyperplasia

DNA:

deoxyribonucleic acid

EAC:

endocervical adenocarcinoma

EBV:

Epstein–Barr virus

ER:

estrogen receptor

FIGO:

International Federation of Gynecology and Obstetrics

HPV:

human papillomavirus

HSIL:

high-grade squamous intraepithelial lesion

IECC:

International Endocervical Adenocarcinoma Criteria and Classification

ISH:

in situ hybridization

iSMILE:

invasive stratified mucin-producing carcinoma

LAST:

Lower Anogenital Squamous Terminology

LEEP:

loop electrosurgical excision procedure

LEGH:

lobular endocervical glandular hyperplasia

LSIL:

low-grade squamous intraepithelial lesion

MGH:

microglandular hyperplasia

mRNA:

messenger ribonucleic acid

N/C:

nuclear-to-cytoplasmic

NEC:

neuroendocrine carcinoma

NOS:

not otherwise specified

PAS:

periodic acid-Schiff

PR:

progesterone receptor

SCC:

squamous cell carcinoma

SCJ:

squamocolumnar junction

SISCC:

superficially invasive squamous cell carcinoma

SMILE:

stratified mucin-producing intraepithelial lesion

WHO:

World Health Organization

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  1. Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Kruti P. Maniar, Luis Z. Blanco Jr & Jian-Jun Wei

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    Jian-Jun Wei

  2. Department of Pathology, Yale School of Medicine, New Haven, CT, USA

    Pei Hui

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Maniar, K.P., Blanco, L.Z., Wei, JJ. (2021). HPV-Associated Cervical Neoplasia. In: Wei, JJ., Hui, P. (eds) Practical Gynecologic Pathology. Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-68608-6_3

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