الفهرس 
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Abstract
Title: Value of immunohistochemical expression of P16 INK4A in various form of cervical neoplasia
Background: Cervical carcinoma represents a major public health problem particularly in developing countries with an age adjusted cancer mortality rate up to 10/10 000. HPV is detected in 99% of cervical tumors.P16 diffuse immunohistochemical expression has been established as a surrogate marker for high risk HPV strains identification. Squamous cell carcinoma accounts for 70-80% of cancer cervix whereas, adenocarcinoma accounts for 10-15%. Cervical intraepithelial neoplasia/ lesions (CIN/CIL) are considered risk factors for cancer cervix. Whilst HGSIL represent an absolute precursor lesion, LSIL only progresses to cancer in 10-15% of cases. The trend of progress to cancer still represents a zone of ambiguity especially among LSIL. Another zone of confusion in diagnosing cervical carcinoma is its putative morphological overlap with endometrial adenocarcinoma, a pitfall that has important management consequences.
Aim: The aim of this study is to evaluate the possible role of immunohistochemical expression of p16INK4A in improving the diagnostic performance of different grades of cervical neoplasia (cervical intraepithelial neoplasia and cervical carcinomas). Further, correlation between p16INK4A expression will be done with the various clincopathologic parameters.
Materials and methods: Immunohistochemical expression of P16INK4A was investigated in 42 cases of cervical neoplasia. These included 7 cases of LGSIL, 4 cases of HGSIL, 17 cases of cervical squamous cell carcinoma, 5 cases of endocervical carcinoma and 9 cases of endometrial carcinoma reaching to the cervix. Semi quantitative assessment using a combined (intensity/percentage) score was interpreted to evaluate expression. Statistical correlation of immunohistochemical results to medical data and microscopic diagnosis was done.
Results: P16INK4A expression showed a highly significant difference between groups as regard overall score with highest score among HGSIL cases (10.5± 3.0) and lowest among Endometrial Carcinoma (3.1 ±3.48), (P value 0.002) . Also, there was a highly significant difference between groups as regard overall marker result (P value 0.009).Moreover, upon comparing lesions of cervical origin to endometrial carcinomas there was a highly significant difference between the two groups as regard overall score (P value 0.002) and marker result (P value 0.003) with higher score and more positive results among lesions of cervical origin. There was no significant statistical correlation between age or parity of patients and P16INK4A expression.
Conclusion: P16INK4A is a useful conjunction prognostic marker in CIL lesions refining morphological detection of high risk groups. Furthermore, it offers additional diagnostic benefit in verifying cervical origin of adenocarcinoma extending to the endometrium when the clinical/microscopic evaluation is non conclusive.