Cervical carcinomas with a micropapillary component: a clinicopathological study of 8 cases

Abstract

Aims

Micropapillary carcinomas, or carcinomas with a micropapillary component, are well-recognised in the breast and other anatomical sites. However, they have seldom been described in the cervix. In this report we present a clinicopathological analysis of eight cervical tumours that showed at least a focal (≥5%) component of micropapillary carcinoma.

Methods and Results

The study group comprised eight cervical carcinomas (4 adenocarcinomas and 4 adenosquamous carcinomas) with a micropapillary component. The median patient age was 41.5 years (range 27-65 years). Five patients were stage IB, two were stage IIB, and one was stage IV at presentation. The micropapillary component accounted for ≤25% of the tumour on initial biopsy or resection specimens in all but one case. Immunohistochemistry showed 'inside-out' (reverse polarity) MUC1 staining along the cell membrane abutting the stroma. Four patients developed metastasis all of which demonstrated a pure micropapillary pattern; this led to a misdiagnosis of an apparently independent peritoneal serous carcinoma in one case. All tumours demonstrated diffuse p16 expression and the three tested cases tumours were positive for HPV18. Three of the six patients with at least 12 months follow-up died of disease while one is alive with distant metastasis.

Conclusions

Usual-type (HPV-related) cervical carcinomas may show micropapillary differentiation, usually as a focal finding, and the cells demonstrate reverse polarity as with similar tumours arising in other sites. Micropapillary cervical carcinoma appears to be a clinically aggressive malignancy although this needs to be confirmed in larger studies.

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