Female genital tract lesions with putative prostatic differentiation include vaginal tubulosquamous polyp (TSP), cervical ectopic prostatic tissue (EPT), and adenoid basal carcinoma (ABC). HoxB13 is a transcription factor specific for the prostate, not previously assessed in these lesions. A cohort of 13 TSPs, 6 EPTs, 17 ABCs, and 8 adenoid basal hyperplasia (ABH) was analyzed for expression of prostatic markers HoxB13, NKX3.1, p16, and androgen receptor (AR). Additional 28 cervical high-grade squamous intraepithelial lesions (HSILs), 21 cervical squamous cell carcinomas (SCCs), 19 endocervical adenocarcinomas (EACs), and 10 endometrial endometrioid adenocarcinomas (ECs) were included. The results were recorded as immunoreactive score (IRS). In TSPs and EPTs, HoxB13 and NKX3.1 were positive in 100% and 89.5% of cases, respectively. No HoxB13, NKX3.1, and p16 was observed in ABHs. In contrast, all ABCs showed diffuse p16 positivity. NKX3.1 was positive in 82.6% of ABCs (median IRS = 2), HoxB13 was positive in 100% of ABCs (median IRS = 8), and the difference was statistically significant (p < 0.001). Both HoxB13 and NKX3.1 were positive in 9.5% (2/21) SCCs and 21.1% (4/19) EACs. Additionally, 40% (4/10) ECs were HoxB13-positive (IRS = 1-2). Any positivity of HoxB13 was 80% specific and 100% sensitive for the ABC. NKX3.1 was only 82.4% sensitive, but 88% specific for the diagnosis of ABC. Additionally, HoxB13 was also seen in 29.8% HSILs. No ABC showed AR positivity, while this was observed in rare cells (IRS 1-2) in 30.8%, 16.6%, and 37.5% of TSCs, EPTs, and ABHs, respectively. HoxB13 can be a useful and reliable marker for identification of TSPs, EPTs and ABCs.

Department of Pathology 3rd Faculty of Medicine Charles University University Hospital Královské Vinohrady Srobarova 50 Praha 10 Prague 100 34 Czech Republic

Department of Pathology and Molecular Medicine 3rd Faculty of Medicine Charles University Thomayer University Hospital Videnska 800 Praha 4 Prague 140 59 Czech Republic

Department of Pathology Charles University 1st Faculty of Medicine and General University Hospital Prague Studnickova 2039 Nové Mesto Prague 128 00 Czech Republic

Department of Pathology Military University Hospital Prague U Vojenske Nemocnice 1200 Praha 6 Prague 169 02 Czech Republic

Department of Urology 1st Faculty of Medicine Charles University and Military University Hospital Prague Prague Czech Republic

The Fingerland Department of Pathology Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové Sokolska 581 Hradec Kralove 500 05 Czech Republic

Unilabs Pathology K S Evropska 2589 33B Praha 6 Prague 160 00 Czech Republic

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