title: Human Papillomavirus-Related Ovarian Metastasis With Endocervical Adenocarcinoma: Report of 2 Cases and Review of Literature.
abstract: BACKGROUND
  Most endocervical adenocarcinomas are associated with human papillomavirus (HPV) infection. Studies suggest that synchronous endocervical and ovarian tumors can contain identical HPV subtypes and that, in this setting, the ovarian tumors likely represent metastases from the endocervical adenocarcinoma rather than 2 independent primaries. However, there are still relatively few reports in the literature.
  
  
  RESULTS
  We describe 2 patients with HPV-related endocervical adenocarcinoma or adenocarcinoma in situ who had metastatic ovarian tumors that simulated primary ovarian neoplasms. After total hysterectomy and bilateral salpingo-oophorectomy, patient 1, in her mid-40s, was diagnosed with endocervical adenocarcinoma in situ and patient 2, in her early 50s, was diagnosed with endocervical adenocarcinoma showing early focal stromal invasion. The ovarian tumors in both cases simulated independent borderline mucinous tumors without evidence of surface involvement or spread beyond the ovary. However, in both cases, the cervical and ovarian tumors showed diffuse, strong P16 staining and contained identical high-risk HPV subtypes (subtypes 16 and 18 in patient 1 and subtype 16 in patient 2). Patient 1 was treated with radiation therapy and remains recurrence free 5 years after diagnosis, and patient 2 has recently completed combined modality treatment with radiation therapy and cisplatin chemotherapy and remains recurrence free 10 months after diagnosis.
  
  
  CONCLUSIONS
  A high index of suspicion and ancillary testing, including P16 immunostaining and molecular genetic testing for HPV, is required to properly diagnose and subclassify HPV-related endocervical adenocarcinoma metastatic to the ovary.
authors.affiliation: 1Department of Pathology and Molecular Medicine, Queen's University, Kingston General Hospital, Kingston; and 2Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Gulisa
authors.initials: G
authors.lastname: Turashvili
authors.forename: Patricia
authors.initials: P
authors.lastname: Farmer
authors.forename: Terence
authors.initials: T
authors.lastname: Colgan
authors.forename: Timothy
authors.initials: T
authors.lastname: Childs
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D000818:Animals; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007150:Immunohistochemistry; D008853:Microscopy; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology*; D009363:Neoplasm Proteins / Q000032:analysis; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000150:complications*
chemical_list: C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004279:DNA, Viral; D009363:Neoplasm Proteins