Objective: This report describes a case that illustrates the limitations of the vaccination screening process for human papillomavirus (HPV) infection.
Case: We report an unexpected microinvasive adenocarcinoma of the cervix arising in a young woman vaccinated against HPV as part of a clinical trial 6 years previously and followed up annually by cytology. In January 2012, at age 23 years, the patient received a cytological result of atypical squamous cells, cannot exclude high-grade cervical squamous intraepithelial lesion, and colposcopy showed slight abnormalities. Biopsy revealed an adenocarcinoma in situ. Conization of the cervix was performed, and the diagnosis was microinvasive adenocarcinoma. Polymerase chain reaction and immunohistochemical study of conization material showed positivity for HPV-18 L1, p16, and Ki-67. Retrospective analysis of the clinical trial information revealed that 7 HPV tests had been performed, and all were positive for HPV-18, including the sample collected before the first vaccination.
Conclusions: HPV-18 was present in the cervix before vaccination. Persistent detection of HPV-18 should be considered an important factor in treatment planning. This case demonstrates the need to vaccinate women before their first sexual contact and highlights the need for keeping adequate screening even in vaccinated individuals.
HPV-18 infection of the cervix occurred before vaccination, the timing of vaccination is related to the protection achieved, and screening must be maintained.
1Faculty of Medical Sciences, State University of Campinas, Campinas (SP); and 2Laboratory Bacchi, Botucatu (SP), Brazil
Reprint requests to: Julio Cesar Teixeira, PhD, Rua Alexander Fleming, 101 – Cidade Universitaria, Campinas (SP) 13083-881, Brazil. E-mail: firstname.lastname@example.org
J.C. Teixeira, E.R.Z. Oliveira, and C.S.C. Teixeira have received funding through their institutions to do HPV vaccine studies for GlaxoSmithKline Biologicals. J.C. Teixeira have received consulting fees, payment for lectures including service on speakers bureau, and travel reimbursements from GlaxoSmithKline Biologicals. For the remaining authors, none were declared.
The authors did not receive financial support for this study.