{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:25:58Z","timestamp":1790886358770,"version":"4.1.0"},"reference-count":38,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2019,1,3]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The International Endocervical Adenocarcinoma Criteria and Classification (IECC) was recently proposed as an improved method for categorising endocervical adenocarcinoma (EA) into human papillomavirus (HPV)\u2013associated adenocarcinomas (HPVAs) and non-HPV-associated adenocarcinomas (NHPVAs). Such categorisation correlates with patient age and tumour size; however, its association with patient outcome remains to be established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Institutional cases of EA with histological material available were selected. Three gynaecological pathologists independently classified all tumours according to the IECC with consensus review used when necessary. Clinicopathologic variables were recorded for each case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of a total of 87 EAs, 71 (82%) were classified as HPVA and 16 (18%) as NHPVA. Among HPVA, most were usual type (51\/71, 72%) followed by mucinous not otherwise specified (10\/71, 14%) and invasive stratified mucin-producing carcinoma (ISMC, 8\/71, 11%). Most NHPVAs were of gastric type (12\/16, 71%) followed by clear cell and mesonephric (two each, 12%). Compared with HPVAs, NHPVAs were significantly associated with older age (p&lt;0.001), larger horizontal extent (p=0.013), greater depth of invasion (p=0.003), lymphovascular space invasion (p&lt;0.001), advanced stage (p&lt;0.001) and invasive pattern C (p&lt;0.001). On univariate analysis, worse disease-free survival (DFS) and disease-specific survival (DSS) correlated with NHPVA group. Among the HPVA subtypes, ISMC showed worse DFS and DSS compared with other HPVA types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The simple morphological approach of the IECC appears to be prognostically valuable. NHPVA (in particular gastric type) and ISMC (a recently recognised subset of HPVA) have an adverse outcome and their recognition following the IECC is important. We provide further evidence to replace the current WHO classification with the IECC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jclinpath-2018-205632","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T06:32:47Z","timestamp":1548397967000},"page":"347-353","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":100,"title":["International Endocervical Adenocarcinoma Criteria and Classification (IECC): correlation with adverse clinicopathological features and patient outcome"],"prefix":"10.1136","volume":"72","author":[{"given":"Anjelica","family":"Hodgson","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterina","family":"Olkhov-Mitsel","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke E","family":"Howitt","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University Medical Center, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa R","family":"Nucci","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-7291","authenticated-orcid":false,"given":"Carlos","family":"Parra-Herran","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"2025121400345926000_72.5.347.1","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2000.5826"},{"key":"2025121400345926000_72.5.347.2","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1089\/jwh.2011.3385","article-title":"Cervical cancer trends in the United States: a 35-year population-based analysis","volume":"21","author":"Adegoke","year":"2012","journal-title":"J Womens Health"},{"key":"2025121400345926000_72.5.347.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9440(10)64619-6"},{"key":"2025121400345926000_72.5.347.4","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29651"},{"key":"2025121400345926000_72.5.347.5","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1002\/ijc.29722","article-title":"The complex relationship between human papillomavirus and cervical adenocarcinoma","volume":"138","author":"Molijn","year":"2016","journal-title":"Int J Cancer"},{"key":"2025121400345926000_72.5.347.6","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2014.55"},{"key":"2025121400345926000_72.5.347.7","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800316"},{"key":"2025121400345926000_72.5.347.8","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2010.100323"},{"key":"2025121400345926000_72.5.347.9","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/PAS.0b013e31821534b9","article-title":"Unusual endocervical adenocarcinomas: an immunohistochemical analysis with molecular detection of human papillomavirus","volume":"35","author":"Park","year":"2011","journal-title":"Am J Surg Pathol"},{"key":"2025121400345926000_72.5.347.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000213434.91868.b0"},{"key":"2025121400345926000_72.5.347.11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/1471-0528.13071","article-title":"HPV-negative carcinoma of the uterine cervix: a distinct type of cervical cancer with poor prognosis","volume":"122","author":"Rodr\u00edguez-Carunchio","year":"2015","journal-title":"BJOG: Int J Obstet Gy"},{"key":"2025121400345926000_72.5.347.12","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1097\/PAS.0000000000000532","article-title":"Gastric-type endocervical adenocarcinoma: an aggressive tumor with unusual metastatic patterns and poor prognosis","volume":"39","author":"Karamurzin","year":"2015","journal-title":"Am J Surg Pathol"},{"key":"2025121400345926000_72.5.347.13","unstructured":"Kurman R , Carcangiu M , Herrington C . 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