Difference between revisions of "Adenocarcinoma of the uterine cervix"

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Adenocarcinoma of the uterine cervix (view source)

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#redirect [[Uterine_cervix#Adenocarcinoma_of_the_uterine_cervix]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Cervical_adenocarcinoma_-_high_mag.jpg
| Width      =
| Caption    = Cervical adenocarcinoma. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[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
| Stains    =
| IHC        = p16 +ve, CEA +ve, vimentin -ve, ER -ve, PR -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[uterine cervix]] - endocervical canal
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = fairly good
| Other      =
| ClinDDx    = other cervical tumours
| Tx        = 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 of the uterine cervix|squamous cell carcinoma]], it is associated strongly with the [[human papilloma virus]].
 
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]].<ref name=pmid26457350>{{Cite journal  | last1 = Karamurzin | first1 = YS. | last2 = Kiyokawa | first2 = T. | last3 = Parkash | first3 = V. | last4 = Jotwani | first4 = AR. | last5 = Patel | first5 = P. | last6 = Pike | first6 = MC. | last7 = Soslow | first7 = RA. | last8 = Park | first8 = KJ. | title = Gastric-type Endocervical Adenocarcinoma: An Aggressive Tumor With Unusual Metastatic Patterns and Poor Prognosis. | journal = Am J Surg Pathol | volume = 39 | issue = 11 | pages = 1449-57 | month = Nov | year = 2015 | doi = 10.1097/PAS.0000000000000532 | PMID = 26457350 }}</ref>
 
==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 [[colon|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===
<gallery>
Image:Cervical_adenocarcinoma_-_low_mag.jpg | Cervical adenocarcinoma - low mag. (WC)
Image:Cervical_adenocarcinoma_-_intermed_mag.jpg | Cervical adenocarcinoma - intermed. mag. (WC)
Image:Cervical_adenocarcinoma_-_high_mag.jpg | Cervical adenocarcinoma - high mag. (WC)
</gallery>
<gallery>
Image: Endocervical_adenocarcinoma_(1).jpg | Endocervical adenocarcinoma. (WC/KGH)
Image: Endocervical_adenocarcinoma_(2).jpg | Endocervical adenocarcinoma. (WC/KGH)
Image: Endocervical_adenocarcinoma_(3).jpg | Endocervical adenocarcinoma. (WC/KGH)
Image: Endocervical_adenocarcinoma_(4).jpg | Endocervical adenocarcinoma. (WC/KGH)
</gallery>
 
==IHC==
Features for diagnosis:
*p16 +ve.
**May be negative ~25% of cases in one series.<ref name=pmid23626605>{{Cite journal  | last1 = Izadi-Mood | first1 = N. | last2 = Asadi | first2 = K. | last3 = Shojaei | first3 = H. | last4 = Sarmadi | first4 = S. | last5 = Ahmadi | first5 = SA. | last6 = Sani | first6 = S. | last7 = Chelavi | first7 = LH. | title = Potential diagnostic value of P16 expression in premalignant and malignant cervical lesions. | journal = J Res Med Sci | volume = 17 | issue = 5 | pages = 428-33 | month = May | year = 2012 | doi =  | PMID = 23626605 }}</ref>
*Ki-67 -- high.
 
Uterus vs. cervix:<ref name=pmid20335127>{{Cite journal  | last1 = Hu | first1 = WW. | last2 = Tao | first2 = JH. | last3 = Li | first3 = GM. | last4 = Xu | first4 = X. | last5 = Yang | first5 = XM. | title = [Value of ER, VIM, CEA and p16 detection in the diagnosis and differential diagnosis of primary endocervical and endometrial adenocarcinomas]. | journal = Nan Fang Yi Ke Da Xue Xue Bao | volume = 30 | issue = 3 | pages = 526-8, 531 | month = Mar | year = 2010 | doi =  | PMID = 20335127 }}</ref>
*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]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Uterine cervix]]
Michael
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