Adenocarcinoma of the uterine cervix

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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:

Images

  • Cervical adenocarcinoma - low mag. (WC)

  • Cervical adenocarcinoma - intermed. mag. (WC)

  • Cervical adenocarcinoma - high mag. (WC)

IHC

Features for diagnosis:

  • p16 +ve.
    • May be negative ~25% of cases in one series.[1]
  • Ki-67 -- high.

Uterus vs. cervix:[2]

  • 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

  1. ↑ 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.
  2. ↑ LAE. 15 January 2009.
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