p16 and human papillomavirus discordance in abdominal metastatic recurrence following chemoradiotherapy for gastric-type endocervical adenocarcinoma

Cervical carcinoma commonly spreads to adjacent structures and pelvic lymph nodes, with ovarian metastases being rare (0.6%–8%). Persistent high-risk human papillomavirus (HPV) infection, present in 95% of cervical cancers, is the primary etiologic factor, and p16 serves as a surrogate marker, although discordance may occur. We present a 53-year-old woman with prior endocervical adenocarcinoma who developed metastatic recurrence to the ovary, fallopian tube, omentum, and appendix, 8 months after concurrent chemoradiation and brachytherapy. The ovarian specimen and the previous cervical biopsy tissue tested positive for p16, with the ovarian specimen consistent with metastatic adenocarcinoma from the cervix. However, the subjection of both specimens to HPV testing yielded negative results. Studies have shown intermediate survival outcomes for p16+/HPV − cancers and shorter survival outcomes for p16−/HPV − and HPV+/p16 − cancers. Although HPV status currently does not alter cervical cancer management, understanding the prognostic and potential therapeutic implications of p16 and HPV discordance remains an important area for future research.