A very rare case of HPV-53-related cervical cancer, in a 79-year-old woman with a previous history of negative Pap cytology.
The introduction of organized cervical cancer (CC) screening programs has drastically reduced the prevalence of CC. However the incidence is still too high, especially among elderly women. All guidelines strongly recommend a regular Papanicolaou (Pap) testing for young and middle-aged patients. On the other hand, many international professional societies no longer advise screening in women who have undergone hysterectomy, and in women aged 65 years and above, who have a previous history of regular Pap smears. Here we report the case of poorly differentiated CC, involving the pelvic lymph nodes and urinary bladder, occurring in a 79-year-old woman who regularly underwent Pap tests, with no reported cytological abnormalities. In this very rare case, the CC cells, as well as cells from metastatic lymph nodes and cells from urinary specimens, molecularly showed human papilloma virus (HPV)-53. With the limitations of a single case, this report brings important information to prevent CC in elderly patients: the utility of molecular tests to increase sensitivity of Pap smears in postmenopausal women; the importance of HPV-53 as one of the four "emergent" genotypes having a possible role in oncogenesis; and the presence of HPV-53 in lymph node metastases from cervical carcinoma, which would support the role of this virus in the maintenance of malignant status.
Cytopathology Unit, Experimental and Clinical Sciences Department, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Roberta
R
Zappacosta
Surgical Pathology Unit, SS Annunziata Hospital, Chieti, Italy.
Giuseppe
G
Lattanzio
Surgical Pathology Unit, SS Annunziata Hospital, Chieti, Italy.
Patrizia
P
Viola
Obstetrics and Gynecology Unit, SS Annunziata Hospital, Chieti, Italy.
Manuel Maria
MM
Ianieri
Cytopathology Unit, Experimental and Clinical Sciences Department, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Daniela Maria Pia
DM
Gatta
Cytopathology Unit, Experimental and Clinical Sciences Department, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Sandra
S
Rosini
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000821:virology; D002584:Cervix Uteri / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000821:virology
HPV genotyping; HPV-DNA test; cervical cancer screening; molecular tests; old women