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Silva pattern-based classification for HPV-associated invasive adenocarcinoma

Silva pattern-based classification for HPV-associated invasive adenocarcinoma
Pattern A
No destructive stromal invasion
Well-demarcated glands with rounded contours, commonly forming groups
No single cells or cell detachment
Complex intraglandular growth allowed (ie, cribriform, papillae), less than a 4× field (5 mm in diameter)
No solid growth or high-grade cytology
No LVI
Irrelevant relationship to large cervical vessels or depth of the tumor
Pattern B
Localized (limited, early) destructive stromal invasion arising from well-demarcated glands (pattern A-like glands)
Individual, ragged glands or small clusters of tumor cells, separated from the rounded glands, usually in an inflamed or desmoplastic stroma
Foci may be single, multiple, or linear at the base of the tumor, less than a 4× field (5 mm in diameter)
No solid growth
LVI (±)
Pattern C
Diffuse destructive invasion:
  • Infiltrative glands that are variable in shape and size, often angulated or interconnected
Confluent growth:
  • Glands or papillary structures with little intervening stroma or mucin lakes with tumor cells within the cervical stroma and filling a 4× field (5 mm)
Solid:
  • Poorly differentiated component (architecturally high grade) with sheets of large malignant cells
Extensive linear destructive:
  • Diffuse laminar EACs ≥5 mm
  • Tumor cells or individual glands are present in a desmoplastic stroma at the base of the tumor
Band-like lymphocytic infiltrate:
  • Superficial prominent band-like lymphoid infiltrate that obscures the neoplastic aggregates
Micropapillary:
  • Numerous small clusters of tumor cells
LVI (±)
EACs: endocervical adenocarcinomas; HPV: human papilloma virus; LVI: lymphovascular invasion.

Adapted with permission from: Roma AA, Diaz De Vivar A, et al. Invasive endocervical adenocarcinoma: A new pattern-based classification system with important clinical significance. Am J Surg Pathol 2015; 39(5):667-72. Copyright © 2015 Wolters Kluwer Health, Inc. https://journals.lww.com/ajsp/pages/default.aspx.

Updated with information from: Alvarado-Cabrero I, Parra-Herran C, Stolnicu S, et al. The Silva pattern-based classification for HPV-associated invasive endocervical adenocarcinoma and the distinction between in situ and invasive adenocarcinoma: Relevant issues and recommendations from the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S48.

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