Cervical atypical glandular cells and false negative HPV testing: a dramatic reality of the wrong test at the right place

Background: Due to cervical cancer screening the number of squamous cancer have declined. The number of adenocarcinomas (ADCs) does appear to be rising. ADCs are often missed and human papillomavirus (HPV) testing could be helpful in detecting these abnormalities earlier. Case: A 36-year-old woman, who had a normal smear three years earlier, had a pap smear with atypical glandular cells. The L1 HPV test showed that there was no HPV infection. Other HPV tests which looked at E6 and E7 showed an infection with HPV 16. Due to unknown reasons, no action was taken regarding the atypical glandular cells. Two years later the patient was diagnosed with a FIGO Stage IVb ADC of the cervix. The L1 HPV test was still negative and the E6/E7 HPV test was still positive. Despite several multiple treatment modalities she succumbed of her disease two years later leaving behind a young family. Conclusion: HPV test looking only at L1 can give false negative results if the virus is integrated in the human genome.

Human papillomavirus; HPV; Adenocarcinoma; L1; E6; E7; Integration; False negative; Cervical cancer; Prophylactic vaccination; Screening; Cross-protection; HPV testing.

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