Endocervical adenocarcinoma in situ

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Endocervical adenocarcinoma in situ, also adenocarcinoma in situ of the uterine endocervix, is pre-invasive change of the uterine endocervix. It is closely tied to HPV infection.

Endocervical adenocarcinoma in situ
Diagnosis in short

Endocervical adenocarcinoma in situ. H&E stain.
LM DDx tubal metaplasia, Arias-Stella reaction, endometriosis, lower uterine segment epithelium (esp. proliferative phase endometrium), endocervical adenocarcinoma, metastatic adenocarcinoma
IHC p16 +ve
Site uterine cervix - endocervical canal

Associated Dx squamous lesions (LSIL, HSIL)
Prevalence uncommon
Clin. DDx endometrial carcinoma
Treatment typically LEEP
For the cytology see Endocervical adenocarcinoma in situ (cytology)

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:[1]

  1. Nuclear changes - key feature:
    • Variable nuclear stratification.
      • Nuclear crowding/pseudostratification.
    • Nuclear enlargement.
      • Often cigar-shaped nuclei.
    • Coarse chromatin.
    • Small nucleolus or nucleoli.
  2. +/-Mitoses.
  3. +/-Reduced cytoplasmic mucin.
  4. Preservation of glandular architecture.
    • Normal gland spacing - lack of complexity ("lobular pattern").
    • Normal gland depth (subjective).

DDx:

Images

www:

IHC

  • p16 +ve.
  • CEA +ve.
  • Vimentin -ve.

See also

References

  1. Zaino, RJ. (Mar 2000). "Glandular lesions of the uterine cervix.". Mod Pathol 13 (3): 261-74. doi:10.1038/modpathol.3880047. PMID 10757337. http://www.nature.com/modpathol/journal/v13/n3/full/3880047a.html.
  2. Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 167. ISBN 978-0443069208.
  3. URL: http://www.womenshealthsection.com/content/print.php3?title=gynpc006&cat=60&lng=english. Accessed on: 20 March 2013.