不可忽视的例外:子宫颈胃型腺癌与高危型HPV DNA检测阳性的"矛盾"解析OA

Gastric-type endocervical adenocarcinoma(G-EAC)is the most common subtype of non-HPV-associated en-docervical adenocarcinoma.It is highly invasive and is prone to missed diagnosis and misdiagnosis.In clinical practice,some patients with G-EAC test positive for high-risk human papillomavirus(HR-HPV)DNA,which presents diagnostic challenges.Although G-EAC is essentially an HR-HPV-negative tumor,positive HR-HPV DNA results are observed in 10.9％to 23.1％of cases,a rate considerably lower than that of usual-type endocervical adenocarcinoma.The primary reasons for these positive results are assay interference or co-infection,rather than actual HPV infection within the tumor cells.Dif-ferential diagnosis should be based on the gold standard of HR-HPV RNAscope in situ hybridization,integrated with his-topathological features,immunohistochemical markers(such as MUC6,HIK1083,p16,and p53),and clinical manifesta-tions(including vaginal discharge and barrel-shaped cervical enlargement).Clinically,a positive HR-HPV DNA result should not lead to the outright exclusion of G-EAC,nor should a negative result lead to overlooking the possibility of malig-nancy.Establishing a diagnostic system centered on histomorphology,immunohistochemistry,and RNAscope testing can help reduce misdiagnosis and improve patient outcomes.