Recent Updates and Advancements in the Practice of Gynecologic Pathology
By Jane Meggitt
The past few years have proved an exciting time in the world of gynecologic pathology, and more advancements are on the way. This is a time when new tumor subtypes are surfacing while new classification systems are emerging. Expect even greater progress in the 2020s.
Gynecologic Pathology Advances
The advances of gynecologic pathology over the past decade have already enabled more women to live longer lives. Gynecological cancers have declined significantly in the 21st century, and much of that decline is due to more accurate testing and earlier detection.
Once, cervical cancer was among the primary causes of all cancer deaths among women, as per the American Cancer Society. The Pap test resulted in falling death rates as it came into widespread use. More recently, the HPV test was approved as another cervical cancer screening tool. Approximately 90 percent of all cervical cancers are caused by the human papillomavirus.
Of the remaining 10 percent of non-HPV cervical cancers, gastric-type adenocarcinoma (GAS) is the most frequent. The understanding of the entirety of benign, premalignant and malignant GAS lesions continues to evolve.
The HPV test detects the highest risk types of the HPV. These riskier types have a greater potential to cause cervical cancer.
Researchers are developing new tools to identify the molecular alterations occurring during the formation of various gynecologic cancers. New methods for uterine cancer screening, the most common of all gynecologic malignancies, may include cervical cytology specimens, such as the Pap smear.
Next-generation tumor sample sequencing is not only clarifying the molecular underpinnings but is also enabling new strategies for dealing with endometrial cancers in practice. The Cancer Genome Atlas Project has identified four molecular subtypes of endometrial carcinoma. These consist of:
- Ultra-mutated EC with DNA polymerase epsilon (POLE) mutations in the exonuclease domain (POLEEDM)
- Hypermutated EC with microsatellite instability (MSI)
- Low mutation rate EC with low frequency of DNA copy-number alterations (CN-L)
- Low mutation rate EC but with high-frequency of DNA copy-number alterations (CN–H)
This classification on the molecular level should lead to improved diagnostics and treatment determination.
Uterine mesenchymal tumors were formerly classified only as smooth muscle or endometrial stromal neoplasms. New molecular technique applications have identified various lesions with distinct genetic abnormalities.
More diagnostic accuracy is available via the use of immuno-stains and other molecular markers. That is especially valuable in the diagnosis of rare tumor types. New types of tumors have been found. This includes uterine fibrosarcoma-like tumors. Since these tumors may respond to targeted translocation in gene therapy, identifying them is critical.
Chemotherapy Response Score
The establishment of a chemotherapy response score (CRS) in tubo-ovarian high-grade serious carcinoma (HGSC) allows assessment of the histopathologic response and patient prognosis. The CRS system permits oncologists to identify patients who may not respond. These HGSC patients receive increased observation or are candidates for clinical trials.
Other advances include a greater understanding of the role of the fallopian tubes in gynecologic cancer. Not long ago, the fallopian tubes received relatively little attention in HGSC pathogenesis. Now, a closer examination of the role of fallopian tubes in HGSC has led to the detection of preinvasion lesions which were frequently overlooked previously.
At Yosemite Pathology and Precision Pathology, we partner with GYNQ™, the foremost provider of Gynecologic Pathology services. All work is performed by highly experienced, board-certified cytopathologists and surgical pathologists with a special interest in gynecologic pathology. The turnaround time for biopsies is 24 to 48 hours. We also offer molecular test identification for STDs and vaginitis.
To learn how your hospital and practice can benefit from our testing services and specialties, including GYNQ™ Gynecologic Pathology, contact us today. For over 70 years, our laboratory has served as an efficient, quality-focused partner for patient care.
Jane Meggitt’s work has appeared in dozens of publications, including USA Today, Zack’s, Financial Advisor, nj.com, The Houston Chronicle and The Nest. She is a graduate of New York University.