Endocervical adenocarcinoma in situ: Difference between revisions

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#redirect [[Uterine_cervix#Endocervical_adenocarcinoma_in_situ]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Endocervical adenocarcinoma in situ -- very high mag.jpg
| Width      =
| Caption    = Endocervical adenocarcinoma in situ. [[H&E stain]].
| Synonyms  =
| Micro      = Nuclear changes (nuclear crowding/pseudostratification, nuclear enlargement (often cigar-shaped nuclei), coarse chromatin, small nucleolus or nucleoli), +/-mitoses, +/-reduced cytoplasmic mucin, preservation of glandular architecture
| Subtypes  =
| LMDDx      = [[Tubal metaplasia of the uterine cervix|tubal metaplasia]], [[Arias-Stella reaction]], [[endometriosis]], lower uterine segment epithelium (esp. [[proliferative phase endometrium]]), [[endocervical adenocarcinoma]], [[metastasis|metastatic]] adenocarcinoma
| Stains    =
| IHC        = p16 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[uterine cervix]] - endocervical canal
| Assdx      = squamous lesions ([[LSIL]], [[HSIL]])
| Syndromes  =
| Clinicalhx = +/-[[HPV]]
| Signs      =
| Symptoms  = asymptomatic
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = [[endocervical adenocarcinoma]] (invasive), [[endometrial carcinoma]], squamous cervical lesions
| Tx        = typically [[LEEP]]
}}
:''For the cytology see [[Gynecologic cytopathology#Endocervical adenocarcinoma in situ|Endocervical adenocarcinoma in situ (cytology)]]''
'''Endocervical adenocarcinoma in situ''', also '''adenocarcinoma in situ of the uterine endocervix''', is pre-invasive change of the [[uterine cervix|uterine endocervix]]. It is closely tied to [[HPV]] infection.
 
If the context is clear, it may be referred to as '''[[adenocarcinoma in situ]]''', abbreviated '''AIS'''.
 
==General==
*Usually due to [[HPV]].
*May be found together with squamous neoplasias of the cervix.
*AIS of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
*Generally, definitely diagnosed with an ''endocervical curettage'' (ECC).
 
==Gross==
*Not apparent at colposcopy.
 
==Microscopic==
Features:<ref name=pmid10757337>{{Cite journal  | last1 = Zaino | first1 = RJ. | title = Glandular lesions of the uterine cervix. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 261-74 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880047 | PMID = 10757337 | url = http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html }}</ref>
#Nuclear changes - '''key feature''':
#*Variable nuclear stratification.
#**Nuclear crowding/pseudostratification.
#*Nuclear enlargement.
#**Often cigar-shaped nuclei.
#*Coarse chromatin.
#*Small nucleolus or [[nucleoli]].
#+/-Mitoses.
#+/-Reduced cytoplasmic mucin.
#Preservation of glandular architecture.
#*Normal gland spacing - lack of complexity ("lobular pattern").
#*Normal gland depth (subjective).
 
Ioffe, et al, :<ref name=pmid12657929>{{cite journal |author=Ioffe OB, Sagae S, Moritani S, Dahmoush L, Chen TT, Silverberg SG. |title=Proposal of a new scoring scheme for the diagnosis of noninvasive endocervical glandular lesions |journal=Am J Surg Pathol | volume=27 | issue=4| pages=452–460 | year=2003 | pmid=12657929 |pmc= |doi= |url= }}</ref> devised a reproducible schema by which one might discern reactive glandular atypia, glandular dysplasia, and adenocarcinoma in situ, summarized in the table below from the article:
 
Sum the scores for stratification, nuclear atypia, and mitoses/apoptotic bodies<br>
<br>
Stratification<br>
None (0 points)<br>
Mild (1 point)<br>
Moderate (2 points)<br>
Up to the luminal surface (3 points)<br>
<br>
Nuclear atypia<br>
As normal (0 points)<br>
Small (size of normal) or slightly enlarged uniform nuclei, minimal hyperchromasia, little dispolarity, no nucleoli (1 point)<br>
Nuclear enlargement (≤3× normal), moderate anisocytosis/hyperchromasia/dispolarity, occasional small nucleoli (2 points)<br>
Large nuclei (>3× normal), marked anisocytosis, marked hyperchromasia, severe dispolarity, frequent prominent nucleoli (3 points)<br>
<br>
Mitoses and apoptoses in two most active glands, number per gland (average between two glands)<br>
None (0 points)<br>
Less than 0.5 per gland (1 point)<br>
0.6–3.0 per gland (2 points)<br>
>3.0 per gland (3 points)<br>
<br>
Total score 0–3 = benign 4–5 = endocervical glandular dysplasia (EGD) 6–9 = adenocarcinoma in situ
 
 
DDx:
*[[Tubal metaplasia of the uterine cervix|Tubal metaplasia]].
*[[Arias-Stella reaction]].
*[[Endometriosis]].
*Lower uterine segment epithelium<ref name=Ref_GP167>{{Ref GP|167}}</ref> - esp. [[proliferative phase endometrium]] - mitoses rare, NC ratio normal, stroma different.
*[[Endocervical adenocarcinoma]] - often has paradoxical maturation... paler cytoplasm & nuclei than adjacent AIS.
*[[metastasis|Metastatic]] adenocarcinoma.
*[[Proliferative phase endometrium]] - endometrial type stroma, cytoplasm not pale staining, no nuclear atypia (smooth nuclear contour, stratified).
 
===Images===
====Case - ECC====
<gallery>
Image: Endocervical adenocarcinoma in situ -- intermed mag.jpg | AIS - intermed. mag.
Image: Endocervical adenocarcinoma in situ -- high mag.jpg | AIS - high mag.
Image: Endocervical adenocarcinoma in situ -- very high mag.jpg | AIS - very high mag.
Image: Endocervical adenocarcinoma in situ 2 -- intermed mag.jpg | AIS - intermed. mag.
Image: Endocervical adenocarcinoma in situ 2 -- high mag.jpg | AIS - high mag.
Image: Endocervical adenocarcinoma in situ 2a -- very high mag.jpg | AIS - very high mag.
Image: Endocervical adenocarcinoma in situ 2b -- very high mag.jpg | AIS - very high mag.
</gallery>
====Case - biopsy====
<gallery>
Image: Endocervical adenocarcinoma in situ --- intermed mag.jpg | AIS - intermed. mag.
Image: Endocervical adenocarcinoma in situ --- high mag.jpg | AIS - high mag.
Image: Endocervical adenocarcinoma in situ --- very high mag.jpg | AIS - very high mag.
 
Image: Endocervical adenocarcinoma in situ - alt --- intermed mag.jpg | AIS - intermed. mag.
Image: Endocervical adenocarcinoma in situ - alt --- high mag.jpg | AIS - high mag.
Image: Endocervical adenocarcinoma in situ - alt --- very high mag.jpg | AIS - very high mag.
 
Image: Endocervical adenocarcinoma in situ - p16 --- intermed mag.jpg | AIS - p16 - intermed. mag.
Image: Endocervical adenocarcinoma in situ - p16 --- high mag.jpg | AIS - p16 - high mag.
Image: Endocervical adenocarcinoma in situ - p16 --- very high mag.jpg | AIS - p16 - very high mag.
 
Image: Endocervical adenocarcinoma in situ - ki67 --- intermed mag.jpg | AIS - Ki-67 - intermed. mag.
Image: Endocervical adenocarcinoma in situ - ki67 --- high mag.jpg | AIS - Ki-67 - high mag.
Image: Endocervical adenocarcinoma in situ - ki67 --- very high mag.jpg | AIS - Ki-67 - very high mag.
</gallery>
====www====
*[https://www.flickr.com/photos/euthman/1799754415 Endocervical AIS adjacent to normal (flickr.com/euthman)].
*[http://nih.techriver.net/view.php?patientId=99 Endocervical adenocarcinoma in situ (techriver.net)].
*[http://womenshealthsection.com/content/gynpc/gynpc006d.jpg Endocervical adenocarcinoma in situ (womenshealthsection.com)].<ref>URL: [http://www.womenshealthsection.com/content/print.php3?title=gynpc006&cat=60&lng=english http://www.womenshealthsection.com/content/print.php3?title=gynpc006&cat=60&lng=english]. Accessed on: 20 March 2013.</ref>
*[http://nih.techriver.net/view.php?patientId=67 Endocervical adenocarcinoma in situ - cytology (techriver.net)].
 
==IHC==
*p16 +ve.
*CEA +ve.
*Vimentin -ve.
 
==Sign out==
<pre>
UTERINE CERVIX, BIOPSY:
- HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL).
- ENDOCERVICAL ADENOCARCINOMA IN SITU (AIS).
- ACUTE AND CHRONIC INFLAMMATION.
 
COMMENT:
A p16 immunostain marks the full thickness of the squamous epithelium and is
strong. A Ki-67 immunostain marks increased numbers of superficial squamous cells.
 
The atypical endocervical epithelium (interpreted as AIS) is strongly p16 positive
and has an increased proliferative activity with Ki-67 staining.
</pre>
 
===Micro===
The atypical endocervical epithelium (interpreted as AIS) shows marked hyperchromasia, nuclear crowding and moderate nuclear atypia with a relatively abundant cytoplasm ( nucleus to cell size = 1:2 ).
 
==See also==
*[[Endocervical adenocarcinoma]].
*[[Uterine cervix]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Uterine cervix]]
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