Fig. 1A primary squamous cell carcinoma arising in the endometrium and showing continuous upward mucosal extension and serosal involvement. Squamous lesions in the endometrium (A, solid arrow and B) and fallopian tubes (C, D) show bland cytomorphologic features mimicking squamous metaplasia, with obvious stromal invasion of the tubal wall (C, D), ovary, and uterine serosa (A, open arrow). Note that three samples are completely immunonegative for p16INK4a (E) and one had weak, focal staining (F), which can be interpreted as negative.
Fig. 2Squamous cell carcinoma in situ with glandular extension of the uterine cervix (A), showing upward extension to the endometrium (B), fallopian tube (C, D), and ovarian surface (E). Note the residual endometrial glandular epithelium (B, arrow) and ciliated tubal epithelium (D, arrow) over the tumor cells. All tumor cells of cervical origin show diffuse strong positivity for p16 (F).
Fig. 3Human papillomavirus (HPV) DNA chip analysis of 40 subtypes of HPV, including 21 high-risk and 19 low-risk subtypes, in the nine patients of this study (A). Three cervical squamous cell carcinomas are positive for HPV DNA type 16 (B).
Table 1.Clinical, histological, and immunohistochemical features of patients with squamous cell carcinoma involving the upper genital tract
Case No. |
Age (yr) |
Primary site |
Histologic diagnosis |
Involved sites |
p16INK4A
|
HPV DNA |
TP53 |
FIGO stagea
|
Follow-up |
1 |
90 |
Uterine cervix |
Invasive SCC |
C, Em |
+++ |
– |
+ |
IIA2 |
DOD, 10 mo |
2 |
76 |
Uterine cervix |
Invasive SCC |
C, Em, LF |
+++ |
HPV16 |
+ |
IB1 |
DOD, 45 mo |
3 |
72 |
Uterine cervix |
SCC in situ
|
C, Em |
+++ |
– |
– |
0 |
NED |
4 |
69 |
Uterine cervix |
Invasive SCC |
C, Em |
+++ |
HPV16 |
– |
IB1 |
NED |
5 |
42 |
Uterine cervix |
SCC in situ
|
C, RF, BO |
+++ |
HPV16 |
– |
0 |
DOD, 14 mo |
6 |
56 |
Endometrium |
Invasive SCC |
Em, LF, LO, US |
– |
– |
– |
IIIA |
DOD, 13 mo |
7 |
75 |
Fallopian tube |
Invasive SCC |
LO, LF, MS, CS |
– |
– |
++ |
IIc |
NED |
8 |
34 |
Ovary |
Invasive SCC |
RO |
–/+ |
– |
– |
IIIc |
NED |
9 |
48 |
Ovary |
Invasive SCC |
LO, MS, B, CS |
– |
– |
++ |
IV |
DOD, 4 mo |