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Minimal deviation adenocarcinoma of the uterine cervix (view source)
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'''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]] | |||