CLEAR-CELL ADENOSQUAMOUS CARCINOMA OF THE CERVIX - AN AGGRESSIVE TUMOR-ASSOCIATED WITH HUMAN PAPILLIOMAVIRUS-18

Background. It is well recognized that adenocarcinomas and adenosquamo us carcinomas of the cervix are frequently associated with human papil lomavirus (HPV) -16 or -18. However, few studies have investigated ass ociations between histologic variants of these tumors and specific typ es of HPV. Methods. Eleven cases of cervical adenosquamous carcinoma w ith an unusual histologic appearance were characterized using histoche mical and immunohistochemical stains. Sections were tested for the pre sence of HPV DNA using the polymerase chain reaction (PCR) and type sp ecific primers for HPV-16 and -18. Clinical outcome was determined fro m a chart review. Results, All tumors were histologically characterize d by the presence of sheets of cohesive cells with prominent cell bord ers and a vacuolated or clear cytoplasm containing large amounts of gl ycogen. All tumors had focal gland formation and stained positive with mucicarmine stain. Using PCR, HPV-18 DNA was identified in all cases. The youngest patient was 24 years old and the oldest 74 years (mean, 43 years). Eight (73%) of the 11 patients have developed recurrent dis ease with a mean follow-up until recurrence of 9.5 months (range, 3-22 months). Seven (64%) of the 11 patients have died of their cervical t umors. Of the five patients with Stage IB disease, three (60%) have di ed of their cervical tumors. Conclusions. A subset of invasive cervica l adenosquamous carcinoma associated with HPV-18 that has a distinctiv e histologic appearance and an aggressive clinical course is described . The term ''clear cell adenosquamous carcinoma'' is proposed for this unique variant of invasive cervical carcinoma.