Endocervical adenocarcinoma in situ

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	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
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)
Clinical history	+/-HPV
Symptoms	asymptomatic
Prevalence	uncommon
Clin. DDx	endocervical adenocarcinoma (invasive), endometrial carcinoma, squamous cervical lesions
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. 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:

• Tubal metaplasia.
• Arias-Stella reaction.
• Endometriosis.
• Lower uterine segment epithelium - esp. proliferative phase endometrium - mitoses rare, NC ratio normal, stroma different.
• Endocervical adenocarcinoma - often has paradoxical maturation... paler cytoplasm & nuclei than adjacent AIS.
• Metastatic adenocarcinoma.
• Proliferative phase endometrium - endometrial type stroma, cytoplasm not pale staining, no nuclear atypia (smooth nuclear contour, stratified).

Images

• 

  AIS - intermed. mag.

• 

  AIS - high mag.

• 

  AIS - very high mag.

• 

  AIS - intermed. mag.

• 

  AIS - high mag.

• 

  AIS - very high mag.

• 

  AIS - very high mag.

www

• Endocervical AIS adjacent to normal (flickr.com/euthman).
• Endocervical adenocarcinoma in situ (techriver.net).
• Endocervical adenocarcinoma in situ (womenshealthsection.com).
• Endocervical adenocarcinoma in situ - cytology (techriver.net).

IHC

• p16 +ve.
• CEA +ve.
• Vimentin -ve.

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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. 

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.