Definition/General
Introduction:
Cervical papillary carcinoma is a variant of endocervical adenocarcinoma characterized by complex papillary architecture with fibrovascular cores
It includes both invasive and non-invasive forms with variable prognosis depending on invasion depth.
Origin:
Arises from endocervical glandular epithelium with papillary growth pattern
Shows complex branching papillae with central fibrovascular cores
Associated with high-risk HPV infection.
Classification:
WHO Classification includes papillary adenocarcinoma as variant of cervical adenocarcinoma
Subdivided into invasive and non-invasive (villoglandular) forms.
Epidemiology:
Uncommon variant, 2-5% of cervical adenocarcinomas
Peak incidence 25-45 years
Strong HPV association (especially HPV 18)
Variable prognosis based on invasion.
Clinical Features
Presentation:
Abnormal vaginal bleeding
Visible papillary or polypoid cervical lesion
Watery vaginal discharge
May present as exophytic mass.
Symptoms:
Abnormal vaginal bleeding (intermenstrual, postcoital)
Profuse watery discharge
Visible cervical lesion
Pelvic discomfort
May be asymptomatic.
Risk Factors:
High-risk HPV infection (especially HPV 18)
Age 25-45 years
Oral contraceptive use
Multiple sexual partners
Early sexual activity.
Screening:
Pap smear may show atypical glandular cells
HPV testing important
Colposcopy reveals papillary or exophytic lesion
Tissue sampling required.
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Gross Description
Appearance:
Papillary, cauliflower-like, or polypoid lesion
Soft, friable consistency
May have villous surface architecture
Variable size from small to large masses.
Characteristics:
Size variable (0.5-6 cm)
Soft, friable consistency
Pink to gray-white coloration
Complex papillary surface
May bleed easily on manipulation.
Size Location:
Can arise from any part of cervix
May protrude through external os
Superficial or deeply invasive growth patterns possible.
Multifocality:
Usually unifocal lesion
May be associated with endocervical adenocarcinoma in situ
Surface papillary growth prominent.
Microscopic Description
Histological Features:
Complex papillary architecture with branching fibrovascular cores lined by stratified columnar epithelium
Variable nuclear atypia and invasion depth
May show surface and glandular components.
Cellular Characteristics:
Stratified columnar epithelium with variable nuclear atypia
Loss of polarity
Increased nuclear-cytoplasmic ratio
Mitotic activity variable.
Architectural Patterns:
Complex papillary structures with thin fibrovascular cores
May have cribriform areas
Surface papillary growth with possible deep invasion.
Grading Criteria:
Grading based on nuclear features and architectural complexity
Low-grade shows minimal atypia
High-grade shows significant nuclear pleomorphism.
Immunohistochemistry
Positive Markers:
p16 diffuse positive (HPV-associated)
CK7 positive
PAX8 positive
CEA positive
Ki-67 variable based on grade.
Negative Markers:
CK20 negative
CDX2 negative
TTF-1 negative
p63 negative
WT1 typically negative.
Diagnostic Utility:
p16 confirms HPV association
CK7 and PAX8 support Müllerian origin
CEA confirms glandular differentiation
Ki-67 helps assess proliferation.
Molecular Subtypes:
HPV-associated papillary adenocarcinoma
Grading important for prognosis and treatment planning.
Molecular/Genetic
Genetic Mutations:
HPV integration (especially HPV 18)
PIK3CA mutations common
KRAS mutations possible
TP53 mutations in high-grade lesions.
Molecular Markers:
High-risk HPV DNA detection
p16 overexpression
Variable Ki-67 index based on grade
p53 alterations in advanced lesions.
Prognostic Significance:
Prognosis depends on grade and invasion depth
Low-grade superficial lesions have excellent prognosis
High-grade invasive lesions have worse outcomes.
Therapeutic Targets:
Treatment based on grade and stage
Conservative management possible for low-grade superficial lesions
Standard cervical cancer treatment for invasive forms.
Differential Diagnosis
Similar Entities:
Villoglandular adenocarcinoma (low-grade)
Conventional endocervical adenocarcinoma
Endocervical adenocarcinoma in situ
Benign papillary lesions.
Distinguishing Features:
Papillary carcinoma: complex architecture, variable atypia
Villoglandular: superficial, low-grade
Conventional: glandular without papillary pattern.
Diagnostic Challenges:
Distinction between invasive and non-invasive forms
Grading assessment
Recognition of papillary architecture
Depth of invasion measurement.
Rare Variants:
Mixed papillary and conventional adenocarcinoma
Papillary with squamous differentiation
Micropapillary variant.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]