Adenocarcinoma of the uterine cervix

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

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.

It is also known as endocervical adenocarcinoma and cervical adenocarcinoma.

General

• Adenocarcinoma of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
• Arises from the endocervical glands.

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.
  • Endometrioid endometrial carcinoma.
  • Serous endometrial carcinoma.

Images

• 

  Cervical adenocarcinoma - low mag. (WC)

• 

  Cervical adenocarcinoma - intermed. mag. (WC)

• 

  Cervical adenocarcinoma - high mag. (WC)

IHC

Features for diagnosis:

• p16 +ve.
• Ki-67 -- high.

Uterus vs. cervix:

• 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

• Uterine cervix.
• Gynecologic cytopathology.