2020 WHO Classification of Female Genital Tumors

Abstract

The 2020 WHO classification is focused on the distinction between HPV-associated and HPV-independent squamous cell carcinoma of the lower female genital organs. Differentiating according to HPV association does not replace the process of grading; however, the WHO classification does not recommend any specific grading system. VIN are also differentiated according to whether they are HPV(p16)-associated. HPV-independent adenocarcinoma (AC) of the cervix uteri has an unfavorable prognosis. Immunohistochemical p16 expression is considered to be a surrogate marker for HPV association. HPV-associated AC of the cervix uteri is determined using the prognostically relevant Silva pattern.

Keywords: HPV; Silva pattern; p16 immunohistochemistry.

Fig. 1

Clinicopathological characteristics of the 2020 WHO classification of vulvar precancerous lesions ,  ,  ,  ,  ,  .

Fig. 2

Precancerous lesions (VIN) and vulvar carcinoma. a  HPV-associated VIN (usual VIN; u-VIN), b and c  non-keratinizing, HPV-associated squamous cell carcinoma of the vulva with a plump pattern of invasion and p16 positivity (so-called block staining; see text), d  HPV-independent VIN (d-VIN), e and f  keratinizing squamous cell carcinoma of the vulva with a netlike pattern of invasion and aberrant p53 expression (see text).

Fig. 5

Clinicopathological characteristics of the 2020 WHO classification of squamous cell carcinoma of the female genitals ,  ,  ,  ,  ,  , , , ,  ,  ,  ,  ,  ,  .

Fig. 3

Verrucous carcinoma of the vulva: exophytic verrucous growth of well-differentiated squamous cell epithelium with superficial parakeratosis and a sharp demarcation, with only focal infiltration (arrow), from the subjacent stroma.

Fig. 4

Precancerous lesions and carcinoma of the vagina. a  HPV-associated precancerous lesion of the vagina (VAIN 3), b  keratinizing squamous cell carcinoma of the vagina with slight peritumoral desmoplasia and absence of peritumoral inflammation, c  non-keratinizing squamous cell carcinoma of the vagina with a high degree of peritumoral inflammation.

Fig. 6

Classification of adenocarcinoma of the cervix uteri in accordance with the 2020 WHO classification ,  ,  ,  ,  ,  . Small image: strong p16 positivity of a usual-type AC.

Fig. 7

Adenosarcoma of the Uterus: foliaceous tumor growth with very cell-poor stroma (*) showing discrete accentuation of the cell density underneath the superficial epithelium (arrows) with a bland cytology.

Abb. 1

Klinikopathologische Charakteristika der WHO-Klassifikation 2020 der vulvären Präkanzerosen ,  ,  ,  ,  ,  .

Abb. 2

Präkanzerosen (VIN) und Karzinom der Vulva. a  HPV-assoziierte VIN (usual VIN; u-VIN), b und c  nicht keratinisierendes, HPV-assoziiertes Plattenepithelkarzinom der Vulva mit plumpem Invasionsmuster und p16-Positivität (sog. block-staining; s. Text), d  HPV-unabhängige VIN (d-VIN), e und f  keratinisierendes Plattenepithelkarzinom der Vulva mit netzigem Invasionsmuster und aberranter p53-Expression (s. Text).

Abb. 5

Klinikopathologische Charakteristika der WHO-Klassifikation 2020 von Plattenepithelkarzinomen des unteren weiblichen Genitales ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ,  .

Abb. 3

Verruköses Karzinom der Vulva: exophytisch-verruköses Wachstum gut differenzierter Plattenepithelien mit oberflächlicher Parakeratose und scharfer, nur fokal infiltrativer Begrenzung (Pfeil) zum darunterliegenden Stroma.

Abb. 4

Präkanzerosen und Karzinom der Vagina. a  HPV-assoziiertes Präkanzerose der Vagina (VAIN 3), b  keratinisierendes Plattenepithelkarzinom der Vagina mit geringer peritumoraler Desmoplasie und fehlender peritumoraler Entzündung, c  nicht keratinisierendes Plattenepithelkarzinom der Vagina mit hochgradiger peritumoraler Entzündung.

Abb. 6

Einteilung von Adenokarzinomen der Cervix uteri entsprechend der WHO-Klassifikation 2020 ,  ,  ,  ,  ,  . Kleines Bild: starke p16-Positivität eines AC usual type.

Abb. 7

Adenosarkom des Uterus: blattartiges Wachstum des Tumors mit sehr zellarmem Stroma (*), das eine diskrete Akzentuierung der Zelldichte unter dem oberflächlichen Epithel zeigt (Pfeile) mit blander Zytologie.