Adenocarcinoma of the uterine cervix
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Adenocarcinoma of the uterine cervix is a relative uncommon form of cervical cancer. Like the more common squamous cell carcinoma, it is associated strongly with the human papilloma virus.
Adenocarcinoma of the uterine cervix | |
---|---|
Diagnosis in short | |
Cervical adenocarcinoma. H&E stain. | |
LM DDx | microglandular hyperplasia, endocervical adenocarcinoma in situ, metastatic adenocarcinoma (e.g. endometrioid endometrial carcinoma, serous endometrial carcinoma, colorectal adenocarcinoma), villoglandular adenocarcinoma, glassy cell carcinoma, clear cell carcinoma of the cervix |
IHC | p16 +ve, CEA +ve, vimentin -ve, ER -ve, PR -ve |
Site | uterine cervix - endocervical canal |
| |
Prevalence | uncommon |
Prognosis | fairly good |
Clin. DDx | other cervical tumours |
Treatment | radical trachelectomy or radical hysterectomy |
It is also known as endocervical adenocarcinoma and cervical adenocarcinoma.
Very well-differentiated adenocarcinoma of the cervix is covered in minimal deviation adenocarcinoma of the uterine cervix.
General
- Adenocarcinoma of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
- Arises from the endocervical glands.
- Usually HPV related.
- Non-HPV related adenocarcinoma may be syndromic - Peutz-Jeghers syndrome, Li-Fraumeni syndrome.[1]
Microscopic
Features:
- Cells with moderate cytoplasm, typically with basally stratfied nuclei.
- Cytologic changes:
- Nuclear hyperchromasia.
- Nuclear pseudostratification.
- Nuclear enlargement.
- Stromal changes - "desmoplastic stroma/desmoplastic reaction".
- Fibrosis/streaming cells.
- Abnormal architecture:
- Gland fusion.
- Glands too deep -- very fuzzy criterion.
Notes:
- AIS changes - similar to colonic dysplasia.
- AIS may occur together with CIN.
- Not infrequently they (AIS, CIN) occur together - both are due, indirectly, to HPV infection.
- May be difficult to be certain of invasion.
- A feature suggestive of invasion is cytoplasmic eosinophilia.
DDx:
- Microglandular hyperplasia - NC ratio normal, no nuclear atypia.
- Endocervical adenocarcinoma in situ.
- Villoglandular adenocarcinoma.
- Glassy cell carcinoma.
- Metastatic adenocarcinoma.
Images
IHC
Features for diagnosis:
- p16 +ve.
- May be negative ~25% of cases in one series.[2]
- Ki-67 -- high.
- Cervix (typically): CEA +ve, p16 +ve.
- ER -ve, PR -ve, vimentin -ve.
- Uterus (typically): vimentin +ve, ER +ve, PR +ve.
- CEA -ve, p16 -ve.
See also
References
- ↑ Karamurzin, YS.; Kiyokawa, T.; Parkash, V.; Jotwani, AR.; Patel, P.; Pike, MC.; Soslow, RA.; Park, KJ. (Nov 2015). "Gastric-type Endocervical Adenocarcinoma: An Aggressive Tumor With Unusual Metastatic Patterns and Poor Prognosis.". Am J Surg Pathol 39 (11): 1449-57. doi:10.1097/PAS.0000000000000532. PMID 26457350.
- ↑ Izadi-Mood, N.; Asadi, K.; Shojaei, H.; Sarmadi, S.; Ahmadi, SA.; Sani, S.; Chelavi, LH. (May 2012). "Potential diagnostic value of P16 expression in premalignant and malignant cervical lesions.". J Res Med Sci 17 (5): 428-33. PMID 23626605.
- ↑ LAE. 15 January 2009.
- ↑ Hu, WW.; Tao, JH.; Li, GM.; Xu, X.; Yang, XM. (Mar 2010). "[Value of ER, VIM, CEA and p16 detection in the diagnosis and differential diagnosis of primary endocervical and endometrial adenocarcinomas].". Nan Fang Yi Ke Da Xue Xue Bao 30 (3): 526-8, 531. PMID 20335127.