Case 101

A 56 year old female with history of HPV infection and PAP showed ASCUS, what's your morphologic impression of all the screenshots below:

Your interpretation: ?

Your interpretation: ?

Your interpretation: ?

Your interpretation: ?

Here is the p16:

Answer

This is an interesting case, as many focus by morphology is strongly suspicious of adenocarcinoma in situ and the diffuse strong p16 support that. Interestingly, the "benign" looking endocervical gland and the squamous epithelium with focal nuclei enlargement is also diffusely positive for p16.

The overall interpretation:

-Adenocarcinoma in Situ

-Atypical squamous epithelium; see comment

There is diffuse strong expression for P 16 in atypical endocervical glands, indicative of adenocarcinoma in Situ. Estrogen receptor is focally and weakly positive

In addition there is a fragments of squamous epithelium with minimally atypical changes which is diffusely positive for P 16, of uncertain significance. We can not exclude that this represents reactive, post-biopsy site changes.

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD