A 46 year old woman presented to her gynecologist with a history of abnormal pap test (ASC-US).

She underwent colposcopy which disclosed a grossly abnormal appearing cervix. Biopsies were taken yielding multiple irregular fragments of brown tissue. These were processed for histology. Endocervical brushings were also obtained and they were processed for histology and cytology.

The cervical biopsy sample consisted entirely of a malignant tumor (Fig 1, scanning magnification H&E) seen in successively higher power H&E fields in Figs 2-4. The tumor cells are large with well-defined cytoplasmic borders but no evident desmosomes or vacuoles. The cytoplasm is eosinophilic. They nuclei are markedly enlarged and pleiomorphic. The chromatin density and texture are variable. There are readily evident nucleoli, usually one per nucleus. Mitotic figures are frequent and most are morphologically abnormal. Ectatic thin-walled vessels with reactive endothelial cells form the tumor blood supply. A few inflammatory cells are scattered within the tumor.

The immunohistochemical findings are illustrated in the composite Figure 5. The tumor cells showed:

This tumor is positive for HPV 18 DNA, as shown in the gels in Figure 6.

Poorly differentiated squamous cell carcinoma with choriocarcinomatous and hepatoid differentiation, poorly differentiated adenocarcinoma with choriocarcinomatous and hepatoid differentiation, choriocarcinoma involving the uterine cervix, high grade epithelioid sarcoma.

Poorly differentiated squamous cell carcinoma with choriocarcinomatous differentiation.

Comment: Although the expression of ß-hCG in squamous cancers of uterine cervix appears to be more frequent than clinically detected, actual histological features of choriocarcinomatous differentiation are rare. To our knowledge, this is the only such case in which HPV type 18 has been identified.

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