Silva Pattern in Cervical Adenocarcinoma: what pathologists see and what gynecologists need to know-Silva Pattern in Cervical Adenocarcinoma: what pathologists see and what gynecologists need to know

Silva Pattern in Cervical Adenocarcinoma: what pathologists see and what gynecologists need to know

Video Transcription

Video Summary

The IGCS Memego Eco Tumor Board marked eight years of multidisciplinary education with a lecture by gynecologic pathologist Dr. Takako Kiyokawa on the Silva pattern of invasion in HPV-associated cervical adenocarcinoma.<br /><br />The Silva system supplements, but does not replace, staging. Pattern A shows no destructive stromal invasion or lymphovascular invasion (LVI) and carries extremely low metastatic risk. Pattern B has limited destructive invasion (under 5 mm), with or without LVI, and generally low risk. Pattern C shows diffuse destructive invasion and has the highest risk of nodal metastasis, recurrence, and cancer-related death. LVI is especially important in Pattern B and can move a tumor into a higher-risk category. Reliable classification usually requires examination of the entire excision or resection specimen; small biopsies and curettings may not represent the most aggressive area.<br /><br />In the case discussion, participants addressed the difficulty of distinguishing adenocarcinoma in situ from Pattern A on limited samples, assessing invasion depth in conization specimens, and recognizing destructive invasion and benign mimics such as tunnel clusters. The speakers emphasized that pathologists should communicate diagnostic uncertainty, and clinicians should interpret Silva patterns alongside other clinical and pathological findings rather than use them alone to guide treatment.

Keywords

IGCS Memego Eco Tumor Board

Silva pattern of invasion

HPV-associated cervical adenocarcinoma

gynecologic pathology

Pattern A

Pattern B

Pattern C

lymphovascular invasion

destructive stromal invasion