Papillary squamous cell carcinoma of the uterine cervix: an immunophenotypic appraisal of 12 cases

Abstract

Objectives: To evaluate the potential role of human papillomavirus (HPV) in the pathogenesis of papillary squamous cell carcinoma (PSCC) and to determine cell proliferative activity and p53 abnormalities in these rare variants of cervical cancer with the propensity for late recurrence, metastasis, and overall favorable prognosis.Methods: Twelve cases of PSCC were diagnosed between 1990 and 1998. Formalin-fixed paraffin sections of each tumor were stained by standard ABC immunoperoxidase method using antibodies to p53 gene product (CM-10) and Ki-67 (MIB-1). In situ hybridization and polymerase chain reaction for HPV common DNA (ENZO) was used to detect DNA shared by most genital HPV-16. The nuclear reactions for HPV and p53 were recorded as either negative or positive. Staining for Ki-67 was graded as minimal (<10% of cells), moderate (10–50%), and high (>50%).Results: The average age of the patients was 46. Eight patients presented with stage IB1 tumor (67%), three patients with stage IA1 tumor (25%), and one patient with stage IIIA tumor (8%). Three tumors (25%) showed nuclear accumulation of p53. Moderate and high proliferative activity was observed in four (33%) and eight (66%), respectively. No HPV DNA was detected by in situ hybridization, yet 50% were detected by polymerase chain reaction. Eleven patients (92%) were alive as of last contact with a mean follow-up of 15 months (range, 5 days–84 months).Conclusions: PSCCs of the uterine cervix are proliferatively active tumors. They differ from the usual squamous cell carcinomas by the low rate of HPV DNA incorporation into genome and p53 gene abnormality. These phenotypic and genotypic differences may explain the more benign clinical course of PSCC, compared with the typical cervical squamous cell carcinomas of the cervix.