Papillary squamotransitional cell carcinoma of the uterine cervix: A histomorphological and immunohistochemical study of nine cases

Abstract

Background:Papillary squamotransitional cell carcinoma (PSCC) is a distinctive subcategory of squamous cell carcinoma of the uterine cervix. It has a propensity for local recurrence and late metastasis. Histologically, it can be misinterpreted as transitional cell carcinoma, or other papillary lesions of the cervix including squamous papilloma, verrucous carcinoma or cervical intraepithelial neoplasia grade 3 with papillary configuration.Materials and Methods:Nine cases of PSCC of the uterine cervix were diagnosed on a cervical biopsy specimen on routine hematoxylin and eosin (H and E) stained sections. Their clinic-morphological features were analyzed. The cases were further evaluated immunohistochemically by cytokeratin 7 (CK7), cytokeratin 20 (CK20), p53 and Ki-67.Results:The patients ranged in age from 35 years to 75 years; with abnormal uterine bleeding being the most common clinical presentation. All the cases showed papillary architecture with fibrovascular cores lined by multilayered atypical epithelium. Three cell types were observed: Clear, intermediate and basaloid. Stromal invasion was seen in five cases, whereas in the remaining four cases, the biopsy specimen was too superficial to definitely assess invasion. Immunohistochemically, eight cases were CK7+/CK20– and one case was CK7–/CK20–. All nine cases showed nuclear accumulation of mutant p53. Moderate and high proliferative activity was observed in two and seven cases, respectively. Five of patients for whom follow-up information was available underwent radical hysterectomy and two of them were disease free 18 months following treatment.Conclusion:PSCC of the uterine cervix are a clinicomorphologically distinct group of cervical lesions that display a morphologic spectrum. They are potentially aggressive malignant tumors that should be distinguished from transitional cell carcinoma and other papillary lesions of the uterine cervix.

Papillary Squamotransitional Cell Carcinoma Cervix- A Rare Case Report

“…However, in most of reported cases, stromal invasion varies between 55% and 65%. [1,9,10] The clinical presentation of our case was similar to other studies, i.e., elderly lady presenting with postmenopausal bleeding or abnormal pap smear. [5,10] PSTCC's have a complex architecture enabling only a superficial biopsy.…”

“…[9,11,12] Thus the identification of the subtle cytological characteristics with clinical correlation is mandatory to conclude diagnostic and staging dilemma. Further, on histopathological specimens, the stromal invasion is very difficult to see unless deep biopsies are taken, which can be a difficult process due to complex papillary architecture of PSTCC.…”

Prevalence of female reproductive tract cancer in a teaching hospital of Rohtas District, Bihar, India

“…3,7 A rare case of papillary squamotransitional cell carcinoma was diagnosed in an old patient as was detected in an another study. 10 Vaginal bleeding was ascertained in near about three-fourth cases and 63% had complaints of fluid discharge. Vaginal bleeding was ascertained 64-84% in other studies.…”

Metastatic urinary tract cancers in pap test: Cytomorphologic findings and differential diagnosis

“…Interestingly, papillary squamous cell carcinoma of the cervix is a rare tumor that can have varying degrees of transitional and squamous differentiation; however, these tumors are typically HPV-related. 13 In most cases, the diagnosis for these tumors can be teased out with a good clinical history, comparison to the primary specimen, and immunochemical stain analysis when material is available.…”