Endocervical adenocarcinoma in situ: Difference between revisions
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Endocervical adenocarcinoma in situ -- high mag.jpg | | Image = Endocervical adenocarcinoma in situ -- very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Endocervical adenocarcinoma in situ. [[H&E stain]]. | | Caption = Endocervical adenocarcinoma in situ. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | 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 = | | 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 | | 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 | ||
| Line 18: | Line 18: | ||
| Assdx = squamous lesions ([[LSIL]], [[HSIL]]) | | Assdx = squamous lesions ([[LSIL]], [[HSIL]]) | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = +/-[[HPV]] | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = asymptomatic | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = | | Bloodwork = | ||
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| Prognosis = | | Prognosis = | ||
| Other = | | Other = | ||
| ClinDDx = [[endometrial carcinoma]] | | ClinDDx = [[endocervical adenocarcinoma]] (invasive), [[endometrial carcinoma]], squamous cervical lesions | ||
| Tx = typically [[LEEP]] | | Tx = typically [[LEEP]] | ||
}} | }} | ||
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#*Normal gland spacing - lack of complexity ("lobular pattern"). | #*Normal gland spacing - lack of complexity ("lobular pattern"). | ||
#*Normal gland depth (subjective). | #*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: | DDx: | ||
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===Images=== | ===Images=== | ||
====Case - ECC==== | |||
<gallery> | <gallery> | ||
Image: Endocervical adenocarcinoma in situ -- intermed mag.jpg | AIS - intermed. mag. | Image: Endocervical adenocarcinoma in situ -- intermed mag.jpg | AIS - intermed. mag. | ||
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Image: Endocervical adenocarcinoma in situ 2b -- very high mag.jpg | AIS - very high mag. | Image: Endocervical adenocarcinoma in situ 2b -- very high mag.jpg | AIS - very high mag. | ||
</gallery> | </gallery> | ||
www | ====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://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://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> | ||
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*CEA +ve. | *CEA +ve. | ||
*Vimentin -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== | ==See also== | ||