Histomorphological spectrum of small cervical biopsies with p16 staining in pre invasive lesions: A seven year retrospective analysis

Udita Singhal, Pooja Jain, Deepak Kumar Singh

Abstract


Introduction: Uterine cervix is a common site for many neoplastic and non-neoplastic lesions. Nonneoplastic lesions include acute and chronic cervicitis, hyperplasia, polyps and cysts. Neoplastic lesions include pre invasive lesions and cervical cancer. Cervical cancer is the second most common cancer in
Indian women after breast cancer. Histo pathological studies of cervical lesions helps in early diagnosis and proper management of patients. Various biomarkers are available for diagnosis of HPV in pre invasive lesions of cervix.
Aims : To analyse the histo pathological spectrum of cervical lesions and their relation with demographics and clinical presentation in small cervical biopsies. Our aim was also to study the role of p16 immunohistochemistry on a small subset of pre invasive lesions of cervix.
Materials and Methods : This is a hospital based seven year retrospective study of 279 cervical punch biopsies performed on patients from January 2013 to December 2019. Clinical history, demographic details, histopathology (H&E) slides and reports of cervical punch biopsies of the patients were retrieved
from past records and analyzed. Six cases of pre invasive lesions of cervix were studied using p16 immunohistochemistry.
Results : The age range of various cervical lesions was 21 to 70 years with a mean age of 45.5 years. The most common age group affected in non- neoplastic lesions was 30-40 years and among neoplastic lesions it was found to be in 40 to 50 years. White discharge per vaginum was the most common complaint seen in122 (43.7%) cases, followed by backache in 50 (17.9%), abdominal pain in 37 (13.2%). Bleeding per vaginum was noted in 60 (21.5%)
cases and post coital bleeding was reported in 10 cases (3.5%) On histopathological examination, 163 cases (58.4%) were non-neoplastic, 68 (24.37%) were pre-invasive and 48 (17.2%) cases were malignant.
The most common non-neoplastic lesion was endocervical polyp reported in 90 biopsies. Among neoplastic cases, LSIL was seen in 30 (12.1%) HSIL in 37 (13.5%) and condyloma in 1 case (0.35%). Squamous cell carcinoma was diagnosed in 44 cases (15.2%). Adenocarcinoma was seen only in 4 cases (1.4%). The percentage positivity of p16 staining on six biopsies, was 33.3% in LSIL and 66.6% in cases of HSIL. Invasive squamous cell carcinoma was taken as a positive control.
Conclusion : Histopathological diagnosis of cervical punch biopsy is a valuable tool in early diagnosis of neoplastic, pre-invasive and non-neoplastic lesions of cervix.Immunostaining with p16 can be a useful adjunct to routine histopathology in diagnosis of preinvasive lesions of cervix.

Keywords: Cervical biopsy, Cervicitis, Koiliocytosis, Preinvasive lesions, Carcinoma cervix, p16, HPV.


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