A 42-year-old woman undergoes colposcopy for an abnormal Pap smear showing atypical glandular cells. Endocervical curettage reveals adenocarcinoma. Immunohistochemistry shows the tumor is p16 negative, HPV in situ hybridization negative, and CK7 positive with CK20 variable. MUC6 is positive. Which subtype of endocervical adenocarcinoma is this?
- A Endocervical adenocarcinoma, usual type
- B Endocervical adenocarcinoma, gastric type ✓
- C Endocervical adenocarcinoma, intestinal type
- D Endometrioid carcinoma of the cervix
Correct answer: B. Endocervical adenocarcinoma, gastric type
Explanation
Gastric-type endocervical adenocarcinoma is HPV-negative (p16 negative, HPV ISH negative) and shows gastric differentiation with MUC6 positivity. It is an aggressive subtype that does not arise from HPV-driven carcinogenesis. The usual type endocervical adenocarcinoma is HPV-18 associated and shows strong diffuse p16 block positivity. Gastric-type adenocarcinoma is more likely to present at advanced stage and has a worse prognosis than HPV-associated types.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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