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Wang Q, Li Y, Kan G, Fu X, Wang M, Zhu J. Gastric‑type endocervical adenocarcinoma: A report of two cases. Oncol Lett 2024; 28:344. [PMID: 38872865 PMCID: PMC11170259 DOI: 10.3892/ol.2024.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/09/2024] [Indexed: 06/15/2024] Open
Abstract
Gastric-type endocervical adenocarcinoma (GEA) is an uncommon and highly aggressive malignancy, characterized by non-specific clinical manifestations. The limited number of documented cases poses significant challenges in achieving an early preoperative diagnosis. In the present study, two cases of GEA in female patients, aged 46 and 39 years, who presented with the chief complaint of profuse vaginal discharge are described. Both patients underwent a total hysterectomy and bilateral adnexectomy, leading to the definitive diagnosis of GEA through routine pathological and immunohistochemical examination. Following surgery, case one received conventional chemotherapy with paclitaxel and carboplatin, demonstrating no evidence of recurrence during a follow-up period of >2 years. At present, patient B has been followed up for >1 year without any signs of disease recurrence. Given the rarity and diagnostic challenges associated with GEA, further investigations into its pathogenesis and diagnostic modalities are warranted. Additionally, due to its poor prognosis, close surveillance is essential for monitoring potential recurrences. Reporting such cases is crucial in aiding clinicians to make accurate diagnoses and treatment decisions.
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Affiliation(s)
- Qian Wang
- Department of Ultrasound Medicine, The First People's Hospital of Linhai City, Linhai, Zhejiang 317000, P.R. China
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanyu Li
- Department of Ultrasound Medicine, The First People's Hospital of Linhai City, Linhai, Zhejiang 317000, P.R. China
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Guangjuan Kan
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Xiaofeng Fu
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Minyan Wang
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jiang Zhu
- Department of Ultrasound Medicine, and State Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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Horibe Y, Kamoshida T, Takase R, Kashiwazaki S, Kanno T, Motohashi T, Akizawa Y, Nakabayashi A, Kumakiri J, Tabata T. The Utility and Feasibility of Laparoscopic Surgery in Patients Diagnosed With Cervical Cystic Lesions. Cureus 2024; 16:e64309. [PMID: 39130823 PMCID: PMC11316274 DOI: 10.7759/cureus.64309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION This observation study aimed to differentiate between lobular endocervical glandular hyperplasia (LEGH) and gastric-type mucinous carcinoma (GAS) while evaluating the feasibility and efficacy of laparoscopic surgery in the preoperative diagnosis of cervical cystic lesions. METHOD AND MATERIAL A retrospective study was conducted to evaluate the diagnostic process and laparoscopic surgical management of cervical cystic lesions suspected to be LEGH or GAS. Preoperatively and postoperatively, MRI, cytology, histology, tumor marker analysis, and surgical outcomes (blood loss during surgery, operative time) were assessed. Six individuals were selected based on magnetic resonance imaging (MRI) results indicating a preoperative suspicion of LEGH or GAS. These patients underwent laparoscopic surgical treatment without indications of malignancy based on preoperative histology or cytology. RESULTS Initially, all individuals were suspected to have LEGH based on MRI findings. Postoperatively, two patients were diagnosed with LEGH, two with adenocarcinoma in situ (AIS) and minimal deviation adenocarcinoma (MDA), and two showed no notable findings on pathology (one diagnosed endometrioid carcinoma in endometrial tissue). Patients with malignancies exhibited longer surgical times and higher intraoperative blood loss. Preoperatively, no significant variation was observed in maximal lesion diameter between adenocarcinoma and LEGH. However, lesion diameter increased significantly over time in patients with GAS. CONCLUSION Laparoscopic surgery demonstrated feasibility and provided crucial diagnostic and therapeutic outcomes, with no postoperative recurrence observed in cases of malignancy, despite the challenges associated with preoperative differentiation. These findings underscore the potential of laparoscopic surgery in enhancing both diagnostic accuracy and therapeutic efficacy for cervical cystic lesions, offering promise for improved patient outcomes and management strategies in clinical practice.
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Affiliation(s)
- Yu Horibe
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Tsukuru Kamoshida
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ruriko Takase
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Sakie Kashiwazaki
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Toshiyuki Kanno
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Takashi Motohashi
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Yoshika Akizawa
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Akira Nakabayashi
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Jun Kumakiri
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Tsutomu Tabata
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
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Kikkawa N, Sugawara H, Yoshida H, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Kato T, Kusumoto M. Characteristics of the magnetic resonance imaging findings of cervical gastric-type adenocarcinoma. Clin Radiol 2024:S0009-9260(24)00234-4. [PMID: 39013666 DOI: 10.1016/j.crad.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/20/2024] [Accepted: 04/30/2024] [Indexed: 07/18/2024]
Abstract
AIMS This study identified the distinct magnetic resonance imaging findings of cervical gastric-type adenocarcinoma (GAS) that can help differentiate it from squamous cell carcinoma (SCC) and usual-type endocervical adenocarcinoma (UEA) and reveal the radiologic-pathologic correlation. MATERIALS AND METHODS All consecutive patients with cervical GAS treated at our hospital from November 2009 to August 2021 were included. The SCC and UEA cases were considered controls. Tumor location, tumor shape, presence and size of cysts, presence of uterine fluid, and apparent diffusion coefficient (ADC) were evaluated. RESULTS Overall, 18 GAS, 55 SCC, and 23 UEA cases were evaluated. The tumor was located in the entire cervix in 13/18 GAS cases, whereas it was predominantly located in the lower cervix in 38/55 SCC cases and 14/23 UEA cases. Most GAS cases exhibited a diffuse infiltration growth pattern (17/18), whereas most SCC and UEA cases exhibited a mass-forming pattern (39/55 and 20/23, respectively). Moreover, the percentages of cases presenting microcysts or macrocysts and undergoing uterine fluid collection were significantly higher in the GAS group (14/18 and 13/18) than in the SCC and UEA groups. ADC was significantly higher in the GAS group than in the SCC group (1.092 × 10-3 vs. 0.819 × 10-3 mm2/s). CONCLUSION This study revealed that GAS is characterized by tumor presence in the entire cervix, infiltrative growth pattern, intrauterine fluid collection, and frequent microcyst or macrocyst formation. Moreover, ADC was significantly higher in the GAS group than in the SCC group.
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Affiliation(s)
- N Kikkawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - H Sugawara
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - H Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - M Kobayashi-Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Y Tanase
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - M Uno
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - M Ishikawa
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - T Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - M Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Bao Y, Zhang H, Huang W, Luo X, Yao L, Feng G, Yuan L. Novel predictors for identifying cervical minimal deviation adenocarcinoma patients with poor prognosis: a long-term observational study in a tertiary centre. Arch Gynecol Obstet 2024; 309:1483-1490. [PMID: 37695371 DOI: 10.1007/s00404-023-07207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To elucidate the clinicopathological features and prognostic factors of minimal deviation adenocarcinoma (MDA) of the uterine cervix, a clinically rare but highly invasive disease. METHODS This was a retrospective, observational, real-world study of 43 patients with pathologically confirmed MDA at the Obstetrics and Gynaecology Hospital of Fudan University between November 2010 and November 2021. Baseline clinicopathological data were collected and reviewed. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were investigated by univariate and multivariate Cox proportional hazards analyses. RESULTS Chief complaints included irregular vaginal discharge and/or bleeding (74.4%). Preoperative diagnosis was difficult, the detection rate was low (36.8%), all cases showed endophytic lesions, and 88.4% had deep stromal invasion, with biologically aggressive characteristics. The ovarian metastasis rate was high (16.3%, 7/43). The median maximum diameter of the tumour (MDOT) was 4.3 cm (range, 0.5-8.0 cm). MDOT was significantly associated with OS (P = 0.009), and the optimal cut-off value to define bulky MDA was 5.5 cm (P < 0.0001, χ= 21.161) using X-tile software. Independent prognostic factors included MDOT (HR = 10.095, P = 0.001) and ovarian metastasis (HR = 5.888, P = 0.008) for OS and MDOT (HR = 3.944, P = 0.028), ovarian metastasis (HR = 9.285, P = 0.001), and deep infiltration (HR = 3.627, P = 0.048) for PFS. CONCLUSION Endophytic lesion development and ovarian metastasis are likely in MDA. A bulky tumour and ovarian metastasis indicate a worse prognosis. Given the special biological features of MDA, it is more appropriate to use 5.5 cm as the threshold for defining a bulky tumour than it is to use 4 cm. Ovary removal should be given higher priority to improve prognosis.
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Affiliation(s)
- Yiting Bao
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wu Huang
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xukai Luo
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Liangqing Yao
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Guannan Feng
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.
| | - Lei Yuan
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
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Yang L, Duan D, Xiong Y, Liu T, Zhao L, Lai F, Gu D, Zhou L. Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review. Hered Cancer Clin Pract 2024; 22:3. [PMID: 38419118 PMCID: PMC10900695 DOI: 10.1186/s13053-024-00275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal hamartomatous polyps. Gastric-type endocervical adenocarcinoma (G-EAC), a special subtype of cervical adenocarcinoma with non-specific symptoms and signs, is known to occur in approximately 11% of female patients with PJS. CASE PRESENTATION Here, we report a case of PJS in a 24-year-old female with multiple mucocutaneous black macules who complained of vaginal discharge and menorrhagia. Moreover, we first described the multimodal ultrasonographical manifestations of PJS-correlated G-EAC. The three-dimensional reconstructed view of G-EAC on 3D realisticVue exhibited a distinctive "cosmos pattern" resembling features on magnetic resonance imaging, and the contrast-enhanced ultrasound displayed a "quick-up and slow-down" pattern of the solid components inside the mixed cervical echoes. We reported the multimodal ultrasonographical characteristics of a case of PJS-related G-EAC, as well as reviewed PJS-related literature and medical imaging features and clinical characteristics of G-EAC to provide insight into the feasibility and potential of utilizing multimodal ultrasonography for the diagnosis of G-EAC. CONCLUSIONS Multimodal ultrasound can visualize morphological features, solid components inside, and blood supplies of the G-EAC lesion and distinguish the G-EAC lesion from normal adjacent tissues. This facilitates preoperative diagnosis and staging of PJS-related G-EAC, thereby aiding subsequent health and reproductive management for patients with PJS.
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Affiliation(s)
- Liwen Yang
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Duan Duan
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Ying Xiong
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Tianjiao Liu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Lijun Zhao
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Fan Lai
- Department of Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Dingxian Gu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Liuying Zhou
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China.
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Liu S, Liu Y, Zhang H. Minimal deviation adenocarcinoma of the cervix with lymphatic metastasis: A case report. Asian J Surg 2024; 47:1099-1100. [PMID: 37996374 DOI: 10.1016/j.asjsur.2023.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Affiliation(s)
- Shujie Liu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Yinmei Liu
- Department of Gynecology, Linyi People's Hospital, Linyi, 276000, Shandong Province, China
| | - Haiyan Zhang
- Department of Gynecology, Linyi People's Hospital, Linyi, 276000, Shandong Province, China.
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Tremblay E, Samouëlian V, Carmant L, Auclair MH, Undurraga M, Barkati M, Rahimi K, Gougeon F, Péloquin L, Cormier B. Gastric-type adenocarcinoma of the endocervix: Potentially overcoming resistant behavior with surgery. Gynecol Oncol Rep 2023; 50:101282. [PMID: 37840972 PMCID: PMC10570569 DOI: 10.1016/j.gore.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Gastric-type adenocarcinoma of the endocervix (GAS) is a rare form of human papillomavirus-independent cervical cancer commonly described as an insidious disease bearing a poor prognosis. Based on scarce data, uncertainty persists pertaining to its oncologic management. Method All cases of well-differentiated GAS treated at our institution from 2010 to 2021 were reviewed. Clinical characteristics, diagnostic tests results and oncologic outcomes were recorded and analyzed. Kaplan-Meier curves and log rank test were performed to compare survival curves between patients with tumors confined to the cervix (group 1: up to stage IB3) versus locally advanced or metastatic (group 2: stages II to IV). Results Cervical cytologies and biopsies yielded low detection rates (38 and 42% respectively) leading to 87% of patients with locally advanced or metastatic disease at diagnosis. Median overall survival (OS) was 40.0 ± 15.9 months with a clear dichotomy in survival when comparing patients with disease confined to the cervix to those with higher stages (respectively 59.0 vs 12.0 months, p = 0.047). None of the 5 patients initially managed with concurrent chemoradiotherapy (CCRT) responded to treatment but fortunately 3 of the latter achieved remission after surgery. Conclusion Well-differentiated GAS did not show favorable response to chemotherapy and radiation. Surgical resection seems to be a cornerstone in the management of this disease, as all patients who achieved remission were treated with surgery, either upfront or after suboptimal response to CCRT. We suggest considering aggressive upfront surgery when feasible. If CCRT is selected to avoid upfront exenterative procedures, rapid evaluation of tumor response is recommended.
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Affiliation(s)
- Elizabeth Tremblay
- Division of Gynecologic Oncology, CHUM, Canada
- Université de Montréal, Canada
| | - Vanessa Samouëlian
- Division of Gynecologic Oncology, CHUM, Canada
- Université de Montréal, Canada
| | | | - Marie-Hélène Auclair
- Division of Gynecologic Oncology, Hôpital Maisonneuve-Rosemont, Canada
- Université de Montréal, Canada
| | - Manuela Undurraga
- Department of Pediatrics and Gynecology, Hôpitaux Universitaires de Genève, Switzerland
| | - Maroie Barkati
- Department of Radiation Oncology, CHUM, Canada
- Université de Montréal, Canada
| | - Kurosh Rahimi
- Department of Pathology, CHUM, Canada
- Université de Montréal, Canada
| | - François Gougeon
- Department of Pathology, CHUM, Canada
- Université de Montréal, Canada
| | | | - Béatrice Cormier
- Division of Gynecologic Oncology, CHUM, Canada
- Université de Montréal, Canada
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Yoshino A, Kobayashi E, Tsuboyama T, Fukui H, Tomiyama N, Sato K, Morii E, Nakatani E, Komura N, Sawada I, Tanaka Y, Hori K, Yoshimura A, Takahashi R, Iwamiya T, Hisa T, Nishimura S, Kitai T, Yokota H, Shindo M, Miyata H, Hashimoto N, Sakiyama K, Abe H, Ueda Y, Kimura T. Novel Strategy for the Management of Cervical Multicystic Diseases. Ann Surg Oncol 2023; 30:2964-2973. [PMID: 36920588 PMCID: PMC10085883 DOI: 10.1245/s10434-022-13033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/13/2022] [Indexed: 03/16/2023]
Abstract
PURPOSE To investigate the clinical practices of diagnosing multicystic cervical lesions as a means to develop a more appropriate diagnostic algorithm for gastric-type adenocarcinoma (GAS) and its precursors. METHODS Clinical information for 159 surgically treated patients for multicystic disease of the uterine cervix was collected from 15 hospitals. We performed a central review of the MRI and pathological findings. The MRI findings were categorized into four types including two newly proposed imaging features based on the morphology and distribution of cysts, and the diagnosis accuracy was assessed. Among the four MRI types, types 1 and 2 were categorized as benign lesions that included LEGH; type 3 were precancerous lesions (with an assumption of atypical LEGH); and type 4 were malignant lesions. RESULTS The central pathological review identified 56 cases of LEGH, seven with GAS, four with another form of carcinoma, and 92 with benign disease. In clinical practice, over-diagnosis of malignancy (suspicion of MDA) occurred for 12/19 cases (63.2%) and under-diagnosis of malignancy occurred for 4/11 (36%). Among the 118 patients who had a preoperative MRI and underwent a hysterectomy, type 3 or 4 MRI findings in conjunction with abnormal cytology were positively indicative of premalignancy or malignancy, with a sensitivity and specificity of 61.1% and 96.7%, respectively. CONCLUSIONS Although the correct preoperative diagnosis of cervical cancer with a multicystic lesion is challenging, the combination of cytology and MRI findings creates a more appropriate diagnostic algorithm that significantly improves the diagnostic accuracy for differentiating benign disease from premalignancy and malignancy.
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Affiliation(s)
- Ai Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideyuki Fukui
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuaki Sato
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Nakatani
- Graduate School of Public Health (Medical Statistics), Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Naoko Komura
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Ikuko Sawada
- Department of Obstetrics and Gynecology, Itami City Hospital, Itami, Hyogo, Japan
| | - Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka Rousai Hospital, Osaka, Japan
| | - Kensuke Hori
- Department of Obstetrics and Gynecology, Kansai Rousai Hospital, Amagasaki, Hyogo, Japan
| | - Akihiko Yoshimura
- Department of Obstetrics and Gynecology, Bell Land General Hospital, Osaka, Japan
| | - Ryoko Takahashi
- Department of Obstetrics and Gynecology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tadashi Iwamiya
- Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, Japan
| | - Tsuyoshi Hisa
- Department of Obstetrics and Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Sadako Nishimura
- Department of Obstetrics and Gynecology, Sumitomo Hospital, Osaka, Japan
| | - Toshihiro Kitai
- Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital Hyogo, Nishinomiya, Japan
| | - Hiromi Yokota
- Department of Obstetrics and Gynecology, Suita Municipal Hospital, Osaka, Japan
| | - Mariko Shindo
- Department of Obstetrics and Gynecology, Hannan Chuo Hospital, Osaka, Japan
| | - Hiromi Miyata
- Department of Obstetrics and Gynecology, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan
| | - Namiko Hashimoto
- Department of Obstetrics and Gynecology, Nippon Life Hospital, Osaka, Japan
| | - Kanako Sakiyama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hazuki Abe
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Kerwin CM, Markese M, Moroney MR, Smith LP, Patel NU. Adenocarcinoma of the uterine cervix, gastric-type (GAS): a review of the literature focused on pathology and multimodality imaging. Abdom Radiol (NY) 2023; 48:713-723. [PMID: 36334123 DOI: 10.1007/s00261-022-03724-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Adenocarcinoma of the uterine cervix, gastric-type (GAS) is a rare, well-differentiated subtype of HPV-independent endocervical adenocarcinoma. It classically arises in middle-aged women with symptoms, including profuse watery vaginal discharge and abnormal uterine bleeding. Given the rarity of this disease, misdiagnosis is common and prognosis remains poorly defined. Distinct pathology and imaging findings can aid in diagnosis. A literature review was performed to ascertain recurring pathologic and radiologic characteristics of GAS. Key pathologic features of GAS include cytologically benign appearing mucinous glands that infiltrate into the deep stroma and may demonstrate lymphovascular or perineural invasion. Multiple imaging modalities including transvaginal ultrasound, CT, and MRI may aid in diagnosis of GAS, which characteristically is seen as a multicystic mass with solid components. MRI in particular is the preferred imaging study because it offers the best chance of identifying a potential solid component, which is key to making the diagnosis of GAS and distinguishing it from other endocervical diseases processes. Careful attention to histopathologic and radiologic details, in conjunction with clinical correlation, is necessary to distinguish GAS from other multicystic cervical lesions.
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Affiliation(s)
- Clara M Kerwin
- Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA.
| | - Matt Markese
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marisa R Moroney
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lynelle P Smith
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nayana U Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
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10
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You X, He L, Lin Y, Huang L, Wang X, Wang Z. Case Report: A rare case of gastric-type adenocarcinoma of stumps of duplicated cervices in a 49-year-old woman: A case with hidden focus confused us a lot. Front Oncol 2023; 13:1109731. [PMID: 36937446 PMCID: PMC10017523 DOI: 10.3389/fonc.2023.1109731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Gastric-type endocervical adenocarcinoma (G-EAC) is a rare special type of cervical mucinous adenocarcinomas, and it is reported the incidence is unrelated to human papilloma virus infection. We report a rare case of G-EAC in stumps of duplicated cervices in a 49-year-old female patient. The woman complained of post-coital bleeding. She had a didelphic uterus with a duplex cervix, and had undergone subtotal hysterectomy 16 years ago. Gynecological examination revealed a normal-appearing right cervix, but the non-dominant side of the left cervix, which was buried and covered by the side wall of the left vagina, was difficult to view. After exposing, the left side cervix presented a mature appearance which was smaller than a normal cervix. Her serum carbohydrate antigen-19-9 levels was 112.59 U/ml. The right cervix's cytology was normal, whereas the left cervix had unusual glandular epithelial cells. HPV testing on both cervical smears was negative. Adenocarcinoma was identified at 3, 6, 12 o'clock at the right cervix in a colposcopy-directed punch biopsy, while no abnormality was found in the biopsy of the left cervix, nor in the curettage of the double cervices. Pelvic magnetic resonance imaging (MRI) revealed two cervical canals, with a 1.9cm×1.6cm mass inside the left cervix, and the left wall of the right cervix may be involved by the tumor of the left cervix. After much deliberation, we considered that the patient had adenocarcinoma of the left cervix stage IB1. Then, the patient underwent radical cervical resection with bilateral salpingo-oophorectomy and bilateral pelvic lymphadenectomy. Her final histopathology indicated G-EAC of the duplicated cervices. After surgery, she received concurrent chemoradiation. Currently, 29 months after the final chemotherapy was administered, the patient remains healthy. Because G-EAC with duplicated cervices is an uncommon cunning tumor with a bad prognosis, early identification and therapy are recommended to enhance the prognosis. The comprehensive evaluation of symptoms and gynecological examination with cervical cytology, colposcopy-directed punch biopsy, endocervical curettage and MRI examine together may assist in determining an accurate preoperative diagnosis.
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Affiliation(s)
- Xiaolin You
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li He
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Li He,
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Huang
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xihao Wang
- Department of Pathology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhigang Wang
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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11
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Lu J, Na J, Li Y, Wang X, Wang J, Han S. Gastric-type mucinous endocervical adenocarcinomas: A case report and literature review. Front Cell Infect Microbiol 2022; 12:917009. [PMID: 36310872 PMCID: PMC9608851 DOI: 10.3389/fcimb.2022.917009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Gastric-type mucinous endocervical adenocarcinomas (GAS) are new variant types of cervical adenocarcinomas according to the 2014 World Health Organization (WHO) classification. GAS is a unique disease that can be differentiated from typical adenocarcinomas—it is less common and more aggressive and likely to have deep invasion and horizontal diffusion, invasion of the uterus and vagina, early distant metastases, and a lower 5-year survival rate compared to the usual-type cervical cancer. At present, initial treatment and postoperative adjuvant therapy are not conclusive, but early detection and early treatment are a consensus that can improve prognosis. Most of its occurrence has nothing to do with human papillomavirus (HPV) infection. Whether it is only negative for the subtypes that can be detected at present and whether it may be an unknown subtype of infection need to be further explored in the future. The clinical symptoms commonly include aqueous secretion, lower abdominal pain, and elevated serum carbohydrate antigen-19-9 (CA19-9) levels, which may be helpful for diagnosis. MRI and PET-CT can help to describe the characteristics of lesions and judge the state of the systemic metastasis. We believe that early detection and surgical treatment will give patients more benefits. Looking for potential gene and molecular changes and establishing biomarkers to identify molecular targets will be the key to early identification and target therapy.
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Affiliation(s)
| | | | | | | | - Jun Wang
- *Correspondence: Jun Wang, ; Shichao Han,
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12
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Miyahara S, Tsuji K, Shimada M, Shibuya Y, Shigeta S, Nagai T, Umezawa R, Tokunaga H, Jingu K, Yaegashi N. The Impact of Histological Subtype on Survival Outcome of Patients with Stage IIB-IVA Cervical Cancer Who Received Definitive Radiotherapy. TOHOKU J EXP MED 2021; 255:303-313. [PMID: 34911878 DOI: 10.1620/tjem.255.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The impact of histologic subtype on definitive radiotherapy for patients with locally advanced cervical cancer remains unclear. The aim of this retrospective analysis was to assess clinicopathological findings and clinical outcome by histological type in patients with stage IIB-IVA cervical cancer. Ninety-two patients with stage IIB-IVA [International Federation of Gynecology and Obstetrics (FIGO) 2008] cervical cancer, who underwent definitive radiotherapy between 2013 to 2018, were identified as eligible for this study. The clinical information of the eligible patients was obtained from medical records of our hospital. Seventy-eight patients underwent concurrent chemoradiotherapy, and the remaining 14 patients received radiotherapy alone. Of 92 patients, 83 had squamous cell carcinoma (SCC) and 9 had non-SCC histology. Progression-free survival (PFS) rate of patients with non-SCC was significantly worse than of those with SCC (2-year PFS: 62.0% vs. 12.5%, p = 0.0020), but overall survival (OS) rate did not statistically differ between the two subtypes (2-year OS: 82.4% vs. 62.5%, p = 0.2157). Pelvic failure-free (PFF) rate of patients with non-SCC histology was significantly worse than of those with non-SCC (2-year PFF; 88.2% vs. 25.0%, p < 0.0001). In univariate analysis, non-SCC histology was associated with PFS rate, although there was no association with OS rate. In multivariate analysis, non-SCC histology and lymph node metastasis were independent prognostic factors for shorter PFS. In patients with stage IIB-IVA cervical cancer who underwent definitive radiotherapy, patients with non-SCC showed significantly worse PFS rate than those with SCC.
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Affiliation(s)
- Shuko Miyahara
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Keita Tsuji
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Yusuke Shibuya
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Tomoyuki Nagai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Rei Umezawa
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
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13
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Xie Y, Zhou Q, Chen L, Sui L. Pathology Behind Constant Watery Vaginal Discharge: A Rare Case of Uterine Cervical Minimal Deviation Adenocarcinoma. Cancer Manag Res 2021; 13:7929-7935. [PMID: 34703314 PMCID: PMC8541879 DOI: 10.2147/cmar.s334660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/03/2021] [Indexed: 11/23/2022] Open
Abstract
Minimal deviation adenocarcinoma (MDA) of uterine cervix is a rare malignant disease with rather poorer prognosis partially due to the early misdiagnosis. Hence, better understanding of early-stage symptoms is critical. We report a case of a 39-year-old woman came to hospital with a chief complaint of "a watery vaginal discharge for 9 months". She was further diagnosed as having uterine cervical minimal deviation adenocarcinoma in cervical LEEP specimen and MDA stage IIIC1 (FIGO 2018 staging-after correction) in post-hysterectomy histopathology. Currently, the definitive treatment is hysterectomy with adjuvant therapy based on staging. This article gives concise symptoms, history, and images of MDA colposcopy finding and histopathology, through the whole process of diagnosis and treatment for future clinical reference.
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Affiliation(s)
- Yu Xie
- Cervical Diseases Diagnosis and Treatment Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Qi Zhou
- Cervical Diseases Diagnosis and Treatment Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Limei Chen
- Cervical Diseases Diagnosis and Treatment Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Long Sui
- Cervical Diseases Diagnosis and Treatment Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
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14
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Dong Y, Lv Y, Guo J, Sun L. Minimal deviation adenocarcinoma with elevated CA19-9: A case report. World J Clin Cases 2021; 9:5999-6004. [PMID: 34368319 PMCID: PMC8316964 DOI: 10.12998/wjcc.v9.i21.5999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Minimal deviation adenocarcinoma is a rare malignancy with a high rate of misdiagnosis and high aggressiveness, and its diagnosis relies on histopathology. Surgical resection is the preferred and most effective treatment, but the outcomes are often unsatisfactory.
CASE SUMMARY A 60-year-old perimenopausal woman was admitted to the hospital and found to have elevated CA19-9 on physical examination without abdominal pain or vaginal bleeding. Clinical examination and positron emission tomography/computed tomography examination were unremarkable, magnetic resonance imaging examination was suggestive of dominant cervical lesions, and methylation examination was suggestive of malignant lesions. Tissue samples were taken from the suspected cervical lesion, and the final pathologic diagnosis was minimal deviation adenocarcinoma. Based on the pathologic diagnosis of suspected minimal deviation adenocarcinoma, radical abdominal total hysterectomy, bilateral oophorectomy, and pelvic and para-aortic lymph node dissection were performed. The final histological report confirmed minimal deviation adenocarcinoma of the cervix, stage IB2, with lymph node metastasis. Minimal deviation adenocarcinoma is a tumor with aggressive clinical behavior.
CONCLUSION Patients with minimal deviation adenocarcinoma have a lower survival rate than patients with conventional human papillomavirus-related cervical adenocarcinoma. A precise preoperative pathologic diagnosis may reduce the mortality rate due to missed optimal treatment with multiple surgical interventions. To date, there is no therapeutic consensus; therefore, each case must be treated individually.
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Affiliation(s)
- Yan Dong
- Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
| | - Ying Lv
- Department of Radiology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Jing Guo
- Department of Pathology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Lin Sun
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
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15
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Shirali E, Yarandi F, Izadi Mood N, Rahmani M, Ghaemi M. The importance of correct radiological diagnosis in (adenoma malignum): a case report. Oxf Med Case Reports 2021; 2021:omab057. [PMID: 34306723 PMCID: PMC8297637 DOI: 10.1093/omcr/omab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Minimal deviation adenocarcinoma (MDA) of the cervix otherwise known as adenoma malignum is a rare variation of cervical adenocarcinoma. Radiological evaluation plays a great role to ensure an early diagnosis. Here, we report a 48-year-old woman who was presented with a mucoid vaginal discharge 10 years after a supracervical hysterectomy. Despite normal biopsy and cytology, magnetic resonance imaging showed a large cervix and multiple cervical cysts that considered adenoma malignum as a differential diagnosis. She underwent surgery and the pathology confirmed the adenoma malignum. In conclusion, radiologists, as well as gynecologists, and also pathologists may consider MDA among the differential diagnosis in patients with a vaginal discharge and multicysts in the cervix even after hysterectomy despite normal cytology and biopsy.
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Affiliation(s)
- Elham Shirali
- Department of Gynecology & Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Yarandi
- Department of Gynecology & Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Izadi Mood
- Department of Pathology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmani
- Department of Gynecology & Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Schwock J, Starova B, Khan ZF, Mirkovic J, Parra-Herran C, Ko HM, Rouzbahman M, Ghorab Z. Cytomorphologic Features of Gastric-Type Endocervical Adenocarcinoma in Liquid-Based Preparations. Acta Cytol 2020; 65:56-66. [PMID: 33152741 DOI: 10.1159/000511003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gastric-type endocervical adenocarcinoma (GAS) is a recently described, uncommon, and aggressive tumor with distinct morphologic features and HPV-independent etiology. Data on GAS in liquid-based cytology (LBC) Papanicolaou (Pap) test preparations from a North American patient population are scant. We systematically assessed the cytomorphologic characteristics of GAS in LBC from patients in Ontario and examined if glandular cell nuclear area could represent a readily assessable feature which may aid in GAS detection. STUDY DESIGN Pap test slides preceding the diagnosis of GAS were retrieved locally or requested from outside laboratories. A structured review of 15 cytomorphologic features was performed using the available LBC Pap test slides of GAS and a set of usual-type endocervical adenocarcinomas (UEA). Morphometry of the glandular cell nuclear area was performed, and normalized values were compared to UEA and benign endocervical cells. RESULTS At least 1 Pap test (5 ThinPrep®, 11 SurePath®, and 1 direct smear) was available for 14 patients. Original LBC Pap test diagnoses were negative for intraepithelial lesion or malignancy (NILM) (7), adenocarcinoma/carcinoma (6), atypical glandular cells (2), and adenocarcinoma in situ (1). Review detected abnormal glandular cells in 6/7 NILM cases. Honeycomb-like sheets, nuclear enlargement, and microvesicular cytoplasm were the single most common architectural, nuclear, and cytoplasmic features, respectively. Microvesicular cytoplasm (100 vs. 17%), honeycomb-like sheets (87 vs. 8%), prominent nucleoli (93 vs. 25%), and anisonucleosis (93 vs. 50%) were most discriminatory for GAS versus UEA, respectively. Yellow mucin, intranuclear cytoplasmic pseudoinclusions, and goblet/Paneth-like cells were uncommon, but unique for GAS. Glandular cell nuclear area normalized to neutrophils was found to be significantly increased in GAS compared to benign endocervical cells. CONCLUSIONS GAS is under-recognized and may mimic reactive endocervical cells. Awareness of the tumor type and its cytomorphology is critical for early detection. Identification of glandular cells with uniform nuclear enlargement in conjunction with any of the other cytologic features may help avoid false-negative Pap results. Neutrophils may serve as convenient size reference and visual aid.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada,
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, Ontario, Canada
| | - Zanobia F Khan
- Department of Pathology, Lakeridge Health, Oshawa, Ontario, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hyang Mi Ko
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Invasive stratified mucin-producing carcinoma (i-SMILE) of the uterine cervix: report of a case series and review of the literature indicating poor prognostic subtype of cervical adenocarcinoma. J Cancer Res Clin Oncol 2019; 145:2573-2582. [PMID: 31385027 DOI: 10.1007/s00432-019-02991-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Invasive stratified mucin-producing carcinoma (i-SMILE) represents a recently recognized subtype of cervical adenocarcinoma (AC) developing in a background of a stratified mucin-producing intraepithelial lesion (SMILE). Clinical and prognostic data on i-SMILE are limited. METHODS We report a series of five cases with histopathological, immunohistochemical (p16) and PCR analyses. The cases as well as the patients previously published in the literature were reviewed for follow-up information. RESULTS Thirteen cases were identified. The mean age of 47.1 years (range 34-66) was not different from the usual type of cervical AC. 10/13 cases presented with tumors > 2 cm and a polypoid-exophytic appearance. Regardless of tumor size and stage of the disease, 7 out of 11 patients developed recurrent disease after a mean of 7.8 months (range 6 weeks-36 months). Five patients developed distant metastases (three of them in the lungs). Five out of the 11 informative cases died of the disease. All reported cases were positive for high-risk HPV (mainly HPV type 18) and associated with p16-overexpression. CONCLUSION i-SMILE represent a distinct subtype of invasive endocervical AC, associated high-risk HPV infection and strong p16-overexpression. Clinically, i-SMILE may represent an aggressive tumor with early recurrent disease and substantial risk of distant metastatic disease, especially to the lungs.
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18
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Lu S, Shen D, Zhao Y, Kang N, Wang X. Primary endocervical gastric-type adenocarcinoma: a clinicopathologic and immunohistochemical analysis of 23 cases. Diagn Pathol 2019; 14:72. [PMID: 31279344 PMCID: PMC6612122 DOI: 10.1186/s13000-019-0852-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background Endocervical gastric-type adenocarcinoma (GAS) is a rare non-human papillomavirus-associated adenocarcinoma (NHPVA) with morphologic and immunohistochemical features of gastric differentiation. This study aimed to evaluate cytologic and clinicopathological features, differential diagnosis of endocervical GAS. Methods A total of 23 patients diagnosed with endocervical GAS/minimal deviation adenocarcinoma (MDA) at Peking University People’s Hospital between 2009 and 2018 were included. Clinical characteristics, cytologic/histopathologic findings, and immunohistochemical results were collected and analyzed. Results The average age of patients was 51 years old (range from 28 to 73). Cytologically, tall columnar epithelial cells with pale, foamy or vacuolated cytoplasm were mostly common, followed by well-defined cytoplasmic borders. Fourteen endocervical GAS cases demonstrated mild cytologic atypia, and 9 cases showed moderate to marked cytologic atypia. Ovarian and fallopian tube involvement were identified in 5 and 6 cases, respectively. Immunohistochemically, tumor cells were diffusely positive for CK7, MUC6 and CA-IX, but focally positive for CK20 and CDX2. P16 was negative or patchy positive in most cases and p53 mutation was identified in 12 cases (12/21, 57.1%). Conclusions Endocervical GAS shows different morphologic and immunological features from endocervical usual type adenocarcinoma, but it may be difficult to be differentiated from metastatic mucinous adenocarcinoma to cervix due to similar morphology and overlapping immunohistochemical profile. Therefore, awareness of the morphologic features and immunohistochemical profile of GAS will allow pathologists to recognize and accurately diagnose this rare and aggressive entity.
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Affiliation(s)
- Shanshan Lu
- Department of Pathology, Peking University People's Hospital, 11Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, 11Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, 11Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Nan Kang
- Department of Pathology, Peking University People's Hospital, 11Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xingxing Wang
- Department of Pathology, Peking University People's Hospital, 11Xizhimen South Street, Xicheng District, Beijing, 100044, China
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19
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Bonin L, Devouassoux-Shisheboran M, Golfier F. Clinicopathological characteristics of patients with mucinous adenocarcinoma of the uterine cervix: A retrospective study of 21 cases. J Gynecol Obstet Hum Reprod 2019; 48:319-327. [PMID: 30807852 DOI: 10.1016/j.jogoh.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Few studies in the literature take into account the WHO's 2014 redefinition of the characteristics of mucinous adenocarcinoma of the uterine cervix. Our objective was to describe the characteristics of a group of these patients. MATERIAL AND METHODS This was a retrospective descriptive study of patients diagnosed between 1 January 2005 and 31 May 2016 in three hospitals in Lyon, France. All the cases of cervical adenocarcinoma were reanalysed by an expert in gynaecological pathology to retain the mucinous subtypes as defined in the 2014 WHO classification. We analysed their clinical and pathological characteristics. RESULTS Among the 82 cases of cervical adenocarcinoma, 21 (26%) were diagnosed as mucinous. Ten were gastric type, of which four were in the extremely well differentiated form of minimal deviation adenocarcinomas, six were intestinal type, two were signet-ring cell type, and three were not otherwise specified. The patients' mean age was 42 years and 18 patients were premenopausal. The revealing symptom was metrorrhagia in eight cases (38%) and mucinous vaginal discharge in four (19%). Fifteen (72%) of the cervical smear were abnormal. Five (31%) of the 16 patients with gastric or intestinal type adenocarcinoma had a specific radiological presentation: multiple cysts of the uterine isthmus, visible on ultrasound and with T2 hyperintensity on MRI. CONCLUSION Mucinous adenocarcinoma is a rare form of cervical cancer that can be confused with other pathological types. It can be detected using cervical smears and should be suspected in cases of mucinous discharge and characteristic MRI features.
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Affiliation(s)
- Lucie Bonin
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - François Golfier
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
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20
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Bonin L, Devouassoux-Shisheboran M, Golfier F. [Focus on mucinous adenocarcinoma of the uterine cervix]. ACTA ACUST UNITED AC 2019; 47:352-361. [PMID: 30771514 DOI: 10.1016/j.gofs.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 12/24/2022]
Abstract
Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.
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Affiliation(s)
- L Bonin
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
| | - M Devouassoux-Shisheboran
- Service d'anatomie et de cytologie pathologiques, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
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21
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Pirog EC, Park KJ, Kiyokawa T, Zhang X, Chen W, Jenkins D, Quint W. Gastric-type Adenocarcinoma of the Cervix: Tumor With Wide Range of Histologic Appearances. Adv Anat Pathol 2019; 26:1-12. [PMID: 30234500 DOI: 10.1097/pap.0000000000000216] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastric-type endocervical adenocarcinoma (GAS) is a recently described diagnostic entity originally characterized as a tumor with (1) voluminous cytoplasm that is (2) clear or pale eosinophilic, and (3) cells showing distinct cell borders. Since the initial tumor description there has been accumulating experience that the neoplasm, in addition to classic features, may show a wide spectrum of morphologic appearances. This paper describes and illustrates cases of GAS with focal or diffuse findings that include: densely eosinophilic cytoplasm, foamy cytoplasm, goblet cells, glands with elongated, stratified nuclei, glands with small cuboidal cells, glands with flattened cells, papillary growth, single cell infiltration and infiltration with microcystic elongated and fragmented pattern. All these patterns may bring up a differential diagnosis with other cervical malignancies such as usual, intestinal, endometrioid, clear cell, serous, and mesonephric adenocarcinoma. The paper describes the patterns of immunostaining of respective lesions that may aid in the diagnostic process and summarizes the main points of the differential diagnosis. GAS is associated with somatic and germline STK11 mutations and TP53 mutations but is invariably negative for human papilloma virus when tumor only is tested. It shows variation in incidence between countries. Awareness of the spectrum of morphologic appearances in GAS is important for accurate and confident diagnosis. Correct identification of GAS is important due to its propensity for ovarian and other distant metastases, markedly worse prognosis as compared with usual endocervical adenocarcinoma, and its relative resistance to chemotherapy.
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Minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix: clinicopathological analysis of 17 cases. Obstet Gynecol Sci 2018; 61:590-597. [PMID: 30254995 PMCID: PMC6137015 DOI: 10.5468/ogs.2018.61.5.590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinicopathological features of minimal deviation adenocarcinoma (MDA) and to analyze its prognostic factors. Methods We retrospectively analyzed the medical records of 17 patients who were diagnosed with MDA at a single institution between January 2005 and December 2015. Results The median age of the patients was 47.7 years (33–75 years). MDA was diagnosed in 7 patients (41.2%) before performing definitive surgery. Stage IB disease was diagnosed in 12 patients (70.6%) and advanced stage disease (stage II: 3, stage III: 2) in 5. MDA was incidentally diagnosed following hysterectomy for benign conditions in 6 patients. Adjuvant therapy was administered to 13 patients (76.5%). During median follow-up over 33.6 months (7–99 months), 11 patients (64.7%) showed no evidence of disease, 6 (35.3%) showed persistent or recurrent disease and 5 died of the disease. Peutz-Jeghers syndrome was not suspected in any patient, and no mutation was detected in the 3 patients who underwent genetic testing. Univariate analysis showed that advanced stage disease (P=0.016) and lymphovascular space invasion (P=0.002) demonstrated a statistically significant association with poor overall survival (OS) rates. Advanced stage disease continued to show a significant association with poor OS rates (hazard ratio, 2.92; 95% confidence interval, 1.097–7.746; P=0.032) even after multivariate analysis. Conclusion Early diagnosis is important to manage MDA. Clinicians should consider MDA among the differential diagnoses in patients with a suspicious clinical presentation even with negative cervical screening tests.
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Song J, Hu Q, Huang J, Ma Z, Chen T. Multicystic mucinous adenocarcinoma of the uterine cervix compared with benign multicystic lesions: Multiparametric MR features. J Magn Reson Imaging 2018; 48:1336-1343. [PMID: 29624774 DOI: 10.1002/jmri.26038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/20/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Multicystic mucinous adenocarcinoma is rarely recognized and has a high misdiagnosis rate. PURPOSE To distinguish malignant multicystic mucinous adenocarcinomas from benign multicystic lesions in the uterine cervix using multiparametric MR. STUDY TYPE Retrospective. POPULATION Forty patients with seven cystic mucinous adenocarcinomas and 33 benign multicystic lesions. FIELD STRENGTH/SEQUENCE 3.0T. Diffusion-weighted images (DWI) and dynamic contrast-enhanced (DCE) images. ASSESSMENT Lesion size, intracystic hemorrhage, solid component, and heterogeneous enhancement were subjectively assessed, and apparent diffusion coefficient (ADC) values, Ktrans , Kep , and Ve parameters were compared. STATISTICAL ANALYSIS Student's t-test was used to compare age, tumor size, ADC values, and DCE parameters. Pearson's chi-square test was used to compare intracystic hemorrhage, solid component, and heterogeneous enhancement. Receiver-operating-characteristic (ROC) analysis of ADC values, tumor size, and Ktrans were performed. RESULTS The size of mucinous adenocarcinomas was larger than benign multicystic lesions (4.09 ± 2.09 vs. 2.23 ± 0.58 cm, P < 0.001); the area under the curve (AUC) for tumor size was 0.859 with a sensitivity of 71.4% and specificity of 90.9%. Stromal ADC value was lower for mucinous adenocarcinomas (1.19 ± 0.22 vs. 1.68 ± 0.22 × 10-3 mm2 /s, P < 0.001); AUC for stromal ADC value was 0.970, with a sensitivity of 86.4% and specificity of 100.0%. Among quantitative DCE parameters, only ktrans offered a discriminative value (1.72 ± 1.42 vs. 0.69 ± 0.30 min-1 , P = 0.031); the AUC for ktrans was 0.831 with a sensitivity of 71.4% and specificity of 97.0%. Intracystic hemorrhage (3/7), solid component (5/7), and heterogeneous enhancement (4/7) were only found in mucinous adenocarcinomas. Five patients (71.4%) had lymphovascular space invasion and three (42.9%) had lymph node metastasis. The 1-year tumor recurrence or metastasis rate was 28.5% (2/7). DATA CONCLUSION Awareness of multiparametric MR features can assist in the differentiation of mucinous adenocarcinomas from benign multicystic lesions. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1336-1343.
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Affiliation(s)
- Jiacheng Song
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiming Hu
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junwen Huang
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhanlong Ma
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Chen
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kamath GD, Bhatt A, Ramaswamy V. A Rare Case of Adenoma Malignum: Preparing for the Unforeseen. J Obstet Gynaecol India 2017; 67:70-73. [PMID: 28242972 DOI: 10.1007/s13224-016-0895-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Aditi Bhatt
- Fortis Hospitals, 154/9, Bannerghatta Road, Bangalore, 560076 India
| | - Veena Ramaswamy
- Fortis Hospitals, 154/9, Bannerghatta Road, Bangalore, 560076 India
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Magnetic resonance imaging of adenoma malignum of the uterine cervix with pathologic correlation: a case report. Radiol Case Rep 2016; 11:323-327. [PMID: 27920853 PMCID: PMC5128363 DOI: 10.1016/j.radcr.2016.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022] Open
Abstract
Adenoma malignum (AM) is considered a rare subtype of cervical adenocarcinoma. Although previous reports have described magnetic resonance findings, none of these reports evaluated the utility of diffusion-weighted imaging in the differential diagnosis of AM and other multicystic cervical lesions. We present a case report of an AM that did not show restriction on the apparent diffusion coefficient map, which can be explained by the low cellularity of the tumor. This is consistent with the proper correlation between the diffusion imaging and histopathology of the tumor. In this way, AM can present with high apparent diffusion coefficient values, as in benign cervical lesions. Therefore, the combination of a solid multicystic lesion that invades the cervical stroma on T2-weighted magnetic resonance images and the absence of restriction on the apparent diffusion coefficient map are very suggestive of AM.
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Fulmer CG, Hoda RS, Pirog EC, Park KJ, Holcomb K. Cytomorphology of Gastric-Type Cervical Adenocarcinoma on a ThinPrep Pap Test: Report of a p16-Positive Tumor Case. Diagn Cytopathol 2016; 44:710-3. [PMID: 27165398 DOI: 10.1002/dc.23498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/05/2016] [Accepted: 04/23/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Clifton G Fulmer
- Department of Pathology & Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rana S Hoda
- Department of Pathology & Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Edyta C Pirog
- Department of Pathology & Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Holcomb
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Sugihara T, Nakagawa S, Sasajima Y, Matsumoto Y, Takeshita S, Ayabe T. Case of minimal deviation adenocarcinoma: Possible clinical link to lobular endocervical glandular hyperplasia as its origin. J Obstet Gynaecol Res 2014; 41:483-7. [DOI: 10.1111/jog.12538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/15/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Takeru Sugihara
- Department of Obstetrics and Gynecology; School of Medicine; Teikyo University; Tokyo Japan
| | - Shunsuke Nakagawa
- Department of Obstetrics and Gynecology; School of Medicine; Teikyo University; Tokyo Japan
| | - Yuko Sasajima
- Department of Pathology; School of Medicine; Teikyo University; Tokyo Japan
| | - Yasuhiro Matsumoto
- Department of Obstetrics and Gynecology; School of Medicine; Teikyo University; Tokyo Japan
| | - Shigeki Takeshita
- Department of Obstetrics and Gynecology; School of Medicine; Teikyo University; Tokyo Japan
| | - Takuya Ayabe
- Department of Obstetrics and Gynecology; School of Medicine; Teikyo University; Tokyo Japan
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Nishii Y, Fukuda T, Imai K, Yamauchi M, Hashiguchi Y, Ichimura T, Yasui T, Sumi T. Minimal deviation mucinous adenocarcinoma of the uterine cervix that proved difficult to differentiate from endometrial cancer: A case report. Oncol Lett 2014; 8:2481-2484. [PMID: 25364411 PMCID: PMC4214510 DOI: 10.3892/ol.2014.2532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 08/22/2014] [Indexed: 11/06/2022] Open
Abstract
Minimal deviation adenocarcinoma (MDA), also known as adenoma malignum of the uterine cervix, accounts for only ~1% of uterine cervical adenocarcinomas. Adenoma malignum of the uterine cervix was initially described by Gusserow in 1870. Using magnetic resonance imaging (MRI), MDA appears as multilocular lesions with solid components that extend from the endocervical glands to the deep cervical stroma. Cytological evaluation and biopsies have low detection rates, therefore, it is difficult to diagnose MDA accurately prior to treatment. The current study describes a rare case of MDA that was difficult to differentiate from endometrial adenocarcinoma of the corpus uteri preoperatively, as the endometrial biopsy results suggested a well-differentiated endometrioid adenocarcinoma and MRI did not show typical images for MDA. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed under the diagnosis of endometrial cancer, and the mass was subsequently diagnosed as MDA of the uterine cervix by pathological examination of the hysterectomy specimen. Postoperatively, although two types of adjuvant chemotherapy were performed, the remaining tumor continued to grow, causing obstruction of the bilateral ureters and leading to bilateral hydronephrosis. The patient is currently alive with the disease 10 months following the surgery.
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Affiliation(s)
- Yuko Nishii
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Takeshi Fukuda
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Makoto Yamauchi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yasunori Hashiguchi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tomoyo Yasui
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Loureiro J, Oliva E. The spectrum of cervical glandular neoplasia and issues in differential diagnosis. Arch Pathol Lab Med 2014; 138:453-83. [PMID: 24678677 DOI: 10.5858/arpa.2012-0493-ra] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings. OBJECTIVE To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix. CONCLUSIONS Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.
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Affiliation(s)
- Joana Loureiro
- From the Department of Pathology, Instituto Português de Oncologia, Porto, Portugal (Dr Loureiro); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Oliva)
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