Subtypes of Endocervical Carcinoma: A Retrospective, Observational Study at Charlotte Maxeke Johannesburg Academic Hospital (2017–2019)

Abstract

Background: The second most common cancer among women, especially in developing countries, is cervical cancer. Though less frequent than cervical squamous cell carcinoma (SCC), endocervical adenocarcinoma (ECA) is becoming more common worldwide, especially in young women. The decline in SCC is attributed to effective screening initiatives. Objectives: We aimed to assess the prevalence of ECA and its subtypes and to describe the clinicopathological characteristics of patients with these tumours at a tertiary South African institute between 2017-2019. Methods: This was a cross-sectional, descriptive study on 156 ECA patients. Following ethical clearance, demographic data, clinical information, and disease characteristics were obtained from departmental histopathological reports. Descriptive statistics were used to calculate the prevalence of ECA. We interrogated the association between age, Papanicolaou (Pap) smear results, Human Papillomavirus (HPV) status, and Human immunodeficiency virus (HIV) status with ECA. Results: The prevalence of ECA in all malignant cervix carcinoma cases was 6.8% and was more common in younger women. HPV-associated subtypes were the most common variants. The usual type of ECA accounted for 24.4% of cases. HIV status was documented in 64.0% of cases, of which 34.0% were positive. There were no statistically significant associations between ECA subtype and HIV status (p=0.81) or between ECA subtype and Pap smear results. Conclusion: The prevalence of ECA in South Africa is lower compared to Western countries, which may be due to different HPV subtypes or alternate risk factors to those in developed countries HPV prevails as a cause of endocervical carcinoma. HPV morphologic hallmarks serve as a practical guide in classifying ECAs according to their HPV status.