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Gadducci A, Guerrieri ME, Cosio S. Adenocarcinoma of the uterine cervix: Pathologic features, treatment options, clinical outcome and prognostic variables. Crit Rev Oncol Hematol 2019; 135:103-114. [PMID: 30819439 DOI: 10.1016/j.critrevonc.2019.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022] Open
Abstract
Adenocarcinoma accounts for 10-25% of all cervical cancers, and its relative and absolute rate has raised over the past decades. Most, but not all the authors, reported that adenocarcinoma has a greater propensity to lymph node, ovarian and distant metastases and a worse prognosis compared with squamous cell carcinoma. However, whether histologic type is an independent prognostic factor is still a debated issue. Moreover, adenocarcinoma is a very heterogenous disease, including different histological subtypes. Whereas radical hysterectomy and definitive radiotherapy achieve the same clinical outcome in early stage squamous cell carcinoma, surgery seems to obtain better survival compared with definitive radiotherapy in early stage adenocarcinoma. Chemoradiation is the standard treatment for locally advanced cervical cancer regardless of histologic type, although several retrospective studies showed that patients with adenocarcinoma were more likely to die than those with squamous cell carcinoma both before and after concurrent chemoradiation era. The prognostic relevance of biological variables, such as cyclin-dependent kinase inhibitors, p53, cyclooxygenase-2 [COX-2], cell surface tyrosine-kinases and programmed death-ligand [PD-L1], is still under investigation. Palliative chemotherapy is the only treatment option for persistent or recurrent cervical adenocarcinoma not amenable with surgery and radiotherapy. The use of immune checkpoint inhibitors as well as a therapeutic strategy targeting cell surface tyrosine kinases should be adequately explored in this clinical setting.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
| | - Maria Elena Guerrieri
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
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Guo P, Liu P, Yang J, Ren T, Xiang Y. Villoglandular adenocarcinoma of cervix: pathologic features, clinical management, and outcome. Cancer Manag Res 2018; 10:3955-3961. [PMID: 30310316 PMCID: PMC6165782 DOI: 10.2147/cmar.s165817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The objective of the study was to investigate the management and prognosis of patients with villoglandular adenocarcinoma (VGA) of the uterine cervix. Materials and methods The clinical presentation, pathology, management, and prognosis of 41 patients with VGA or other types of cervical adenocarcinoma (ADC) were retrospectively reviewed. Results During the patient follow-up period, the proportion of VGA was 8.1% in the cervical ADC cohort (41/507). The median age of the patients with VGA was 41.0 years. The most common presenting symptom was cervical contactive bleeding. There were 38 patients classified as FIGO stage IA1-IB. The median follow-up period was 38.5 months. There were no patient deaths, and only one patient showed recurrence. One of the patients delivered a healthy baby at 34 weeks of gestation prior to treatment with radical hysterectomy. The HPV HC2 test results showed that most patients were positive for HPV infection. HPV 16, 18, and 56 were positive in the 8 patients with HPV type test results. There were significant differences in the grade, depth of stromal invasion, lymph node metastasis, and recurrence between the VGA cases of FIGO stage I and the other types of cervical ADC of FIGO stage I (p<0.05). Conclusion This study confirmed that VGA is a type of well-differentiated cervical cancer characterized by shallow stromal invasion, less lymph node metastasis. VGA is associated with less recurrence than other types of cervical ADC.
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Affiliation(s)
- Peng Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China, .,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Pengfei Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
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Ju UC, Kang WD, Kim SM. Is the ovarian preservation safe in young women with stages IB-IIA villoglandular adenocarcinoma of the uterine cervix? J Gynecol Oncol 2018; 29:e54. [PMID: 29770624 PMCID: PMC5981105 DOI: 10.3802/jgo.2018.29.e54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/24/2018] [Accepted: 03/06/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Because villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA. Methods We retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015. Results This study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa. Conclusion This study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.
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Affiliation(s)
- U Chul Ju
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
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Genestie C, Kacem CH, Duvillard P. [Glandular lesions of the uterine cervix: Case 4]. Ann Pathol 2016; 36:192-4. [PMID: 27234516 DOI: 10.1016/j.annpat.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Catherine Genestie
- Département de pathologie, Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - Chiraz Hadj Kacem
- Département de pathologie, Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Pierre Duvillard
- Département de pathologie, Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
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Zhao L, Xu T, Cui M, Fu Z. A retrospective review of 11 cases of villoglandular papillary adenocarcinoma of the uterine cervix and a review of the literature. Oncol Lett 2016; 11:2164-2168. [PMID: 26998142 DOI: 10.3892/ol.2016.4172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/13/2016] [Indexed: 11/06/2022] Open
Abstract
Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a rare subtype of cervical adenocarcinoma (AC) that accounts for 3.7-4.8% of cervical AC. Compared with ordinary adenocarcinoma, VGPA is associated with a lower incidence, younger age and better prognosis. Treatment with fertility-preserving surgery is also possible. The present study analyzed cases treated in The Second Hospital of Jilin University (Changchun, Jilin, China) between January 2010 and December 2014. A total of 11 cases were selected; of these, 7 cases were pathologically confirmed. The remaining 4 cases were diagnosed as VGPA upon the pathological examination of the biopsy, but confirmed as another type of adenocarcinoma upon analysis of the surgical pathology. The median age of the patients whose pathology was confirmed post-operatively was 36 years, and all cases were positive for human papillomavirus (HPV). As all 7 patients had no requirement for further fertility, a radical hysterectomy was performed, with or without adjuvant therapy. The follow-up time ranged from 7-57 months, with a mean time of 29 months. There was no evidence of recurrence in any of the patients. All the patients remain alive to date. The results of the present study indicated that HPV infection is likely to be the cause of VGPA, and the prognosis of VGPA tends to be better compared with other types of adenocarcinoma. However, the number of studies that have reported cases of VGPA remains small, and all are retrospective analyses with short follow-up times. Therefore, physicians selecting treatment options for patients with VGPA should exercise caution.
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Affiliation(s)
- Liping Zhao
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Tianmin Xu
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Manhua Cui
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Zeming Fu
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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Zhou QY, Chen HY, Yang SM, Li YH, Wu XQ. Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature. Oncol Lett 2015; 11:837-841. [PMID: 26870293 DOI: 10.3892/ol.2015.3944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 05/15/2015] [Indexed: 11/06/2022] Open
Abstract
To investigate the clinicopathological features, management and prognosis of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix, the current study presents 4 cases of VGPA of the uterine cervix. The median age of the patients was 55 years (range, 47-70 years), with all 4 patients presenting with stage Ib disease. Human papillomavirus (HPV) infection was detected in 3 patients; this was mainly HPV-16. No history of oral contraceptive use was found in these cases. While 2 of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, 1 patient underwent a radical hysterectomy with bilateral pelvic lymphadenectomy and the remaining patient received a simple total hysterectomy plus post-operative radiotherapy. Of these patients, only 1 had been correctly diagnosed pre-operatively. In 2 patients, the biopsy results had been interpreted as cervical adenocarcinoma, and in the third, the biopsy result was of cervical intraepithelial neoplasia. All 4 patients presented with cervical wall invasion, including invasion of the inner two-thirds in 1 patient. No lymphovascular space invasion or lymph node metastasis was detected. The follow-up time ranged from 49 to 83 months (median, 64 months), and the patients are currently alive and well, with no evidence of recurrent disease. Taking these results as a whole, VGPA is an uncommon type of cervical adenocarcinoma, characterized by its excellent prognosis. HPV infection is associated with the molecular pathogenesis of VGPA, while oral contraceptive use can be excluded. As the disease has a low pre-operative diagnostic accuracy, frequent cervical wall invasion and concomitant lesions, conservative treatment strategies should be carefully considered.
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Affiliation(s)
- Qiang-Yong Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hai-Yan Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Si-Meng Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yue-Hua Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xue-Qing Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Prognostic Factors Influencing Decisions About Surgical Treatment of Villoglandular Adenocarcinoma of the Uterine Cervix. Int J Gynecol Cancer 2014; 24:1299-305. [DOI: 10.1097/igc.0000000000000197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ObjectiveThe objectives of this study were to analyze the clinicopathologic features of villoglandular adenocarcinoma (VGA) of the uterine cervix, a variant of cervical adenocarcinoma with good prognosis, and to discuss the association of human papillomavirus (HPV) infection with VGA.MethodsA retrospective review of medical records was performed to identify the patients with VGA between 1999 and 2007 at the Samsung Medical Center.ResultsFifteen patients were identified among 171 women diagnosed with adenocarcinoma of the cervix. The median age was 40 years (range, 32–72 years). Four patients were treated by cone biopsy and 10 patients by hysterectomy with or without pelvic lymphadenectomy. Five patients had invasion of more than half of the depth of tumor in the cervix. Lymphovascular space invasion was present in 2 patients, one of whom also had lymph node metastases. Three recurrences were identified during the median follow-up of 64 months (range, 9–149 months). An HPV test was positive in 6 of 7 patients. Of the 6 patients with HPV infection, 2 were positive for HPV type 18, one for HPV type 6, and the remaining 3 were positive for 1 or more types of high-risk HPV.ConclusionsAlthough VGA has been reported to have a favorable prognosis, we observed recurrences in those patients with close margins by the tumor, lymph node metastasis, or advanced stage. Human papillomavirus DNA, mostly HPV types 16 and 18, was associated with VGA. Further studies are warranted on prognostic factors and the pathogenetic role of HPV infections.
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El adenocarcinoma de cérvix como causa infrecuente de sangrado vaginal en la mujer joven. Semergen 2013; 39:168-70. [DOI: 10.1016/j.semerg.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/13/2012] [Accepted: 01/16/2012] [Indexed: 11/22/2022]
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Choi Y, Kim H, Choi H, Hwang D, Choe G, Chung JH, Park SY, Lee HS, Paik JH, Park HJ. Liquid-based cytology of villoglandular adenocarcinoma of the cervix: a report of 3 cases. KOREAN JOURNAL OF PATHOLOGY 2012; 46:215-20. [PMID: 23110005 PMCID: PMC3479784 DOI: 10.4132/koreanjpathol.2012.46.2.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/06/2012] [Indexed: 11/17/2022]
Abstract
Villoglandular adenocarcinoma (VGA) is a rare subtype of cervical adenocarcinoma with a more favorable prognosis compared to conventional adenocarcinomas. Although the tumors are usually recognized on colposcopic examination due to the mainly exophytic growth pattern, they may be underdiagnosed as benign lesions by cytology because of their minimal cytologic atypia. We report the liquid-based cytology (LBC) findings of three histologically confirmed VGAs which we have recently identified. They were characterized by hypercellular smears on low-power examination with smooth-bordered three-dimensional papillary fragments. The nuclei were relatively uniform with irregular nuclear membranes. Nucleoli were small but distinct and macronucleoli were also seen. The abnormal architectural patterns such as papillary structures and nuclear overlapping and nuclear hyperchromasia are important clues to the diagnosis of VGA. In addition, nuclear membrane irregularity and prominent nucleoli can be recognized on LBC specimens, further facilitating its diagnosis.
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Affiliation(s)
- Younghwa Choi
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Glandular neoplasms of the cervix. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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