Difference between revisions of "Minimal deviation adenocarcinoma of the uterine cervix"

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#redirect [[Uterine_cervix#Minimal_deviation_adenocarcinoma_of_the_uterine_cervix]]
'''Minimal deviation adenocarcinoma of the uterine cervix''' is a very well-differentiated [[adenocarcinoma of the uterine cervix]] associated with [[Peutz-Jeghers syndrome]].
 
It is also known as '''adenoma malignum''' and '''minimal deviation adenocarcinoma''' (abbreviated '''MDA'''). 
 
It is a subset of ''adenocarcinoma of the uterine cervix'', which is dealt with in the [[adenocarcinoma of the uterine cervix]] article.
 
==General==
*Rare and difficult diagnosis.<ref name=pmid12828609>{{Cite journal  | last1 = Tsuda | first1 = H. | last2 = Mikami | first2 = Y. | last3 = Kaku | first3 = T. | last4 = Akiyama | first4 = F. | last5 = Hasegawa | first5 = T. | last6 = Okada | first6 = S. | last7 = Hayashi | first7 = I. | last8 = Kasamatsu | first8 = T. | title = Interobserver variation in the diagnosis of adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. | journal = Pathol Int | volume = 53 | issue = 7 | pages = 440-9 | month = Jul | year = 2003 | doi =  | PMID = 12828609 }}</ref>
**Requires a deep sampling;<ref name=pmid22385609>{{Cite journal  | last1 = Lim | first1 = KT. | last2 = Lee | first2 = IH. | last3 = Kim | first3 = TJ. | last4 = Kwon | first4 = YS. | last5 = Jeong | first5 = JG. | last6 = Shin | first6 = SJ. | title = Adenoma malignum of the uterine cervix: Clinicopathologic analysis of 18 cases. | journal = Kaohsiung J Med Sci | volume = 28 | issue = 3 | pages = 161-4 | month = Mar | year = 2012 | doi = 10.1016/j.kjms.2011.10.009 | PMID = 22385609 }}</ref> thus,  usually diagnosed on cone biopsy or hysterectomy.
*Associated with [[Peutz-Jeghers syndrome]].<ref name=pmid21503748>{{Cite journal  | last1 = Riegert-Johnson | first1 = D. | last2 = Roberts | first2 = M. | last3 = Gleeson | first3 = FC. | last4 = Krishna | first4 = M. | last5 = Boardman | first5 = L. | title = Case studies in the diagnosis and management of Peutz-Jeghers syndrome. | journal = Fam Cancer | volume = 10 | issue = 3 | pages = 463-8 | month = Sep | year = 2011 | doi = 10.1007/s10689-011-9438-x | PMID = 21503748 }}</ref><ref name=pmid22878090>{{Cite journal  | last1 = Ito | first1 = M. | last2 = Minamiguchi | first2 = S. | last3 = Mikami | first3 = Y. | last4 = Ueda | first4 = Y. | last5 = Sekiyama | first5 = K. | last6 = Yamamoto | first6 = T. | last7 = Takakura | first7 = K. | title = Peutz-Jeghers syndrome-associated atypical mucinous proliferation of the uterine cervix: A case of minimal deviation adenocarcinoma ('adenoma malignum') in situ. | journal = Pathol Res Pract | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.1016/j.prp.2012.06.008 | PMID = 22878090 }}</ref>
*Poor prognosis.<ref name=pmid2764221>{{Cite journal  | last1 = Gilks | first1 = CB. | last2 = Young | first2 = RH. | last3 = Aguirre | first3 = P. | last4 = DeLellis | first4 = RA. | last5 = Scully | first5 = RE. | title = Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. | journal = Am J Surg Pathol | volume = 13 | issue = 9 | pages = 717-29 | month = Sep | year = 1989 | doi =  | PMID = 2764221 }}</ref>
*Not associated with [[HPV]] - unlike most [[adenocarcinoma of the uterine cervix]].
 
Note:
*Very well-differentiated adenocarcinoma may also be seen in the stomach;<ref name=pmid15533229>{{Cite journal  | last1 = Nokubi | first1 = M. | last2 = Kawanowa | first2 = K. | last3 = Kawata | first3 = H. | last4 = Hanatsuka | first4 = K. | last5 = Hosoya | first5 = Y. | title = Extremely well-differentiated adenocarcinoma of the gastric cardia: a unique case with columnar cells and laminated stones. | journal = Pathol Int | volume = 54 | issue = 11 | pages = 854-60 | month = Nov | year = 2004 | doi = 10.1111/j.1440-1827.2004.01769.x | PMID = 15533229 }}</ref> however, this does not appear to be related to the well-differentiated adenocarcinoma in the cervix.
 
==Microscopic==
Features:<ref name=Ref_WMSP441-2>{{Ref WMSP|441-2}}</ref>
*Deep infiltrating glands - '''key feature'''.
**Desmoplastic stroma - may be subtle.
**Perivascular and/or perineural location.
*Minimal nuclear atypia.
*Abnormal gland morphology<ref name=pmid2764221/> / loss of lobular (gland) architecture. †
 
Note:
*† '''Not''' a criterion required by all pathologists.<ref name=pmid12828609/>
 
DDx:<ref name=pmid12828609/>
*[[Adenocarcinoma of the uterine cervix]] - has "obvious" [[nuclear atypia]].
*[[Tunnel cluster]].
 
==IHC==
Features:
*[[CEA]] +ve.<ref name=pmid2764221/>
*[[p16]] -ve.<ref name=pmid21497449>{{Cite journal  | last1 = He | first1 = Y. | last2 = Li | first2 = L. | last3 = Jiang | first3 = W. | last4 = Wang | first4 = DQ. | last5 = Xu | first5 = L. | last6 = Huang | first6 = Q. | last7 = Zhang | first7 = Y. | last8 = Yang | first8 = KX. | title = Expression of the insulin-like growth factor-II mRNA-binding protein 3 (IMP3) and carcinoembryonic antigen (CEA) in mucinous minimal deviation adenocarcinoma. | journal = Pathol Res Pract | volume = 207 | issue = 5 | pages = 295-9 | month = May | year = 2011 | doi = 10.1016/j.prp.2011.02.011 | PMID = 21497449 }}</ref>
 
==See also==
*[[Uterine cervix]].
*[[Peutz-Jeghers polyp]].
 
==References==
{{Reflist|2}}


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

Latest revision as of 23:18, 13 March 2016

Minimal deviation adenocarcinoma of the uterine cervix is a very well-differentiated adenocarcinoma of the uterine cervix associated with Peutz-Jeghers syndrome.

It is also known as adenoma malignum and minimal deviation adenocarcinoma (abbreviated MDA).

It is a subset of adenocarcinoma of the uterine cervix, which is dealt with in the adenocarcinoma of the uterine cervix article.

General

Note:

  • Very well-differentiated adenocarcinoma may also be seen in the stomach;[6] however, this does not appear to be related to the well-differentiated adenocarcinoma in the cervix.

Microscopic

Features:[7]

  • Deep infiltrating glands - key feature.
    • Desmoplastic stroma - may be subtle.
    • Perivascular and/or perineural location.
  • Minimal nuclear atypia.
  • Abnormal gland morphology[5] / loss of lobular (gland) architecture. †

Note:

  • Not a criterion required by all pathologists.[1]

DDx:[1]

IHC

Features:

See also

References

  1. 1.0 1.1 1.2 Tsuda, H.; Mikami, Y.; Kaku, T.; Akiyama, F.; Hasegawa, T.; Okada, S.; Hayashi, I.; Kasamatsu, T. (Jul 2003). "Interobserver variation in the diagnosis of adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix.". Pathol Int 53 (7): 440-9. PMID 12828609.
  2. Lim, KT.; Lee, IH.; Kim, TJ.; Kwon, YS.; Jeong, JG.; Shin, SJ. (Mar 2012). "Adenoma malignum of the uterine cervix: Clinicopathologic analysis of 18 cases.". Kaohsiung J Med Sci 28 (3): 161-4. doi:10.1016/j.kjms.2011.10.009. PMID 22385609.
  3. Riegert-Johnson, D.; Roberts, M.; Gleeson, FC.; Krishna, M.; Boardman, L. (Sep 2011). "Case studies in the diagnosis and management of Peutz-Jeghers syndrome.". Fam Cancer 10 (3): 463-8. doi:10.1007/s10689-011-9438-x. PMID 21503748.
  4. Ito, M.; Minamiguchi, S.; Mikami, Y.; Ueda, Y.; Sekiyama, K.; Yamamoto, T.; Takakura, K. (Aug 2012). "Peutz-Jeghers syndrome-associated atypical mucinous proliferation of the uterine cervix: A case of minimal deviation adenocarcinoma ('adenoma malignum') in situ.". Pathol Res Pract. doi:10.1016/j.prp.2012.06.008. PMID 22878090.
  5. 5.0 5.1 5.2 Gilks, CB.; Young, RH.; Aguirre, P.; DeLellis, RA.; Scully, RE. (Sep 1989). "Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases.". Am J Surg Pathol 13 (9): 717-29. PMID 2764221.
  6. Nokubi, M.; Kawanowa, K.; Kawata, H.; Hanatsuka, K.; Hosoya, Y. (Nov 2004). "Extremely well-differentiated adenocarcinoma of the gastric cardia: a unique case with columnar cells and laminated stones.". Pathol Int 54 (11): 854-60. doi:10.1111/j.1440-1827.2004.01769.x. PMID 15533229.
  7. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 441-2. ISBN 978-0781765275.
  8. He, Y.; Li, L.; Jiang, W.; Wang, DQ.; Xu, L.; Huang, Q.; Zhang, Y.; Yang, KX. (May 2011). "Expression of the insulin-like growth factor-II mRNA-binding protein 3 (IMP3) and carcinoembryonic antigen (CEA) in mucinous minimal deviation adenocarcinoma.". Pathol Res Pract 207 (5): 295-9. doi:10.1016/j.prp.2011.02.011. PMID 21497449.