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Park KJ, Selinger CI, Alvarado-Cabrero I, Duggan MA, Kiyokawa T, Mills AM, Ordi J, Otis CN, Plante M, Stolnicu S, Talia KL, Wiredu EK, Lax SF, McCluggage WG. Dataset for the Reporting of Carcinoma of the Cervix: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S64-S89. [PMID: 36305535 DOI: 10.1097/pgp.0000000000000909] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cervical carcinoma remains one of the most common cancers affecting women worldwide, despite effective screening programs being implemented in many countries for several decades. The International Collaboration on Cancer Reporting (ICCR) dataset for cervical carcinoma was first developed in 2017 with the aim of developing evidence-based standardized, consistent and comprehensive surgical pathology reports for resection specimens. This 4th edition update to the ICCR dataset on cervical cancer was undertaken to incorporate major changes based upon the updated International Federation of Obstetricians and Gynecologists (FIGO) staging for carcinoma of the cervix published in 2018 and the 5th Edition World Health Organization (WHO) Classification of Female Genital Tumors published in 2020 and other significant developments in pathologic aspects of cervical cancer. This updated dataset was developed by a panel of expert gynecological pathologists and an expert gynecological oncologist, with a period of open consultation. The revised dataset includes "core" and "noncore" elements to be reported; these are accompanied by detailed explanatory notes and references providing the rationale for the updates. Standardized reporting using datasets such as this helps facilitate consistency and accuracy, data collection across different sites and comparison of epidemiological and pathologic parameters for quality and research purposes.
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Endometrioid Carcinomas of the Ovaries and Endometrium Involving Endocervical Polyps: Comprehensive Clinicopathological Analyses. Diagnostics (Basel) 2022; 12:diagnostics12102339. [PMID: 36292027 PMCID: PMC9600253 DOI: 10.3390/diagnostics12102339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
While synchronous ovarian and endometrial endometrioid carcinomas (ECs) have long been described in the literature, ovarian or endometrial EC involving concomitant endocervical polyp (ECP) has not yet been reported. This study aimed to investigate the histological types and prevalence of gynecological tumors co-existing with ECP and to comprehensively analyze the clinicopathological characteristics of ovarian and endometrial ECs involving ECPs. We searched for ECP cases associated with premalignant lesions or malignancies of the female genital tract occurring between March 2019 and February 2022. We then investigated the histological types and prevalence of gynecological tumors co-existing with ECP. In addition, we reviewed electronic medical records and pathology slides to collect the clinicopathological features of four patients with ovarian or endometrial EC involving ECP. We found 429 ECPs over the three-year study period. Of these, 68 (15.9%) were associated with premalignant or malignant lesions occurring in the uterine cervix, endometrium, and ovaries. Four of these cases, including two (0.5%) ovarian grade 3 ECs and two (0.5%) endometrial grade 1 ECs, involved ECPs. In the former cases (cases 1 and 2), ECs involving ECPs exhibited similar morphology and immunohistochemical staining results to those of advanced-stage ovarian EC. In the latter cases (cases 3 and 4), the histological and immunophenotypical features of EC involving ECP were identical to those of primary endometrial EC, despite the lack of tumor involvement in the myometrium, lower uterine segment, and cervical stroma as well as the absence of lymphovascular invasion and lymph node metastasis. In all cases, no evidence of benign endometriosis, endometrial hyperplasia without atypia, or atypical hyperplasia/endometrial intraepithelial neoplasm within ECP or the adjacent endocervical tissue was noted. Considering our results, the involvement of ECP by EC may have been caused by an implantation metastasis from the ovarian (cases 1 and 2) or endometrial (cases 3 and 4) EC. To the best of our knowledge, this is the first exploration of the synchronous occurrence of endometrial or ovarian EC and ECP involvement. Implantation metastasis via transtubal and trans-endometrial cavity migration may have been the pathogenic mechanism of ECP involvement.
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Yilmaz MT, Gurlek E, Gultekin M, Kahraman K, Salman MC, Usubutun A, Akata D, Lay Ergun E, Arik Z, Yildiz F. Ovarian Carcinoma Presenting With a Large Cervical Mass. Cureus 2022; 14:e20994. [PMID: 35154969 PMCID: PMC8820480 DOI: 10.7759/cureus.20994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Cervical metastasis in ovarian cancer is a rare entity. Therefore, care should be taken in the differential diagnosis of cervical masses as it may mimic a primary tumor. This report aimed to emphasize the importance of a multidisciplinary approach in these tumors. We present a case of a 73-year-old female who presented with post-menopausal vaginal bleeding and cervical mass. The patient was diagnosed with ovarian carcinoma with a multidisciplinary approach. Although cervical metastasis of ovarian cancer is rare, the possibility of secondary cancer should be kept in mind, especially in cervical tumors with atypical clinical course.
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Secondary Involvement of the Uterine Cervix by Nongynecologic Neoplasms: A Detailed Clinicopathologic Analysis. Am J Surg Pathol 2021; 44:1699-1711. [PMID: 32910021 DOI: 10.1097/pas.0000000000001578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary involvement of the uterine cervix by nongynecologic neoplasms is rare accounting for <2% of metastases to the gynecologic tract. This study aimed to analyze the clinicopathologic features of cervical involvement by nongynecologic malignancies. A total of 47 cases were identified including 39 (83%) carcinomas, 6 lymphomas (12.8%), and 2 (4.2%) cutaneous malignant melanomas. The most common primary site of origin among carcinomas was the gastrointestinal tract (27, 69.2%), followed by breast and urothelium (5 each, 12.8%), gallbladder, and lung (1 each, 2.6%). The gynecologic tract was involved at the presentation in 16 patients (34%), including 5 (10.6%) with the cervix being the first site, 7 (14.9%) with synchronous involvement of the cervix and other gynecologic sites, and 4 (8.5%) with the involvement of other gynecologic sites before the cervical presentation. Patients with lymphoma were younger compared with those with carcinoma (43.7 vs. >50.5) (P=0.01). Mean time to identification of cervical metastases was <1 year for gallbladder carcinoma, melanomas, and gastrointestinal signet ring cell carcinomas (P=0.03). Features that varied with different types of metastatic tumor included lymphovascular space invasion, depth of stromal invasion, growth pattern (glands lacking architectural complexity, cribriforming, solid), presence of goblet cells, and signet ring cells, degree of cytologic atypia, and overall findings mimicking a benign/noninvasive process (P≤0.027). Six tumors (12.8%) were initially misdiagnosed as cervical primary. Metastatic nongynecologic tumors can mimic primary in situ or invasive neoplasms in both ectocervix and endocervix. In patients with a known prior malignancy, the clinical history with ancillary studies and a high level of suspicion are crucial to ensure accurate diagnosis.
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Wong RWC, Ng JHY, Han KC, Leung YP, Shek CM, Cheung KN, Choi CKM, Tse KY, Ip PPC. Cervical carcinomas with serous-like papillary and micropapillary components: illustrating the heterogeneity of primary cervical carcinomas. Mod Pathol 2021; 34:207-221. [PMID: 32699256 DOI: 10.1038/s41379-020-0627-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/07/2023]
Abstract
Recent changes in the classification of cervical adenocarcinomas have re-categorized serous carcinoma as potentially nonexistent. However, clinical and pathological profiles of cervical adenocarcinomas with serous-like morphological features have not been systematically evaluated using the latest taxonomy and biomarkers. We studied 14 cases of primary cervical carcinomas with serous-like morphologies (papillary and micropapillary patterns). None of these cases exhibited evidence of serous carcinoma involving the upper tracts. Patient ages ranged between 34 and 86 years, most presented with abnormal uterine bleeding. Histologically, ten cases were classified as human papillomavirus (HPV)-associated carcinomas (eight usual-type endocervical adenocarcinomas and two adenosquamous carcinomas), of which six exhibited a papillary pattern and four had a micropapillary pattern. The four remaining cases were HPV-independent gastric-type adenocarcinomas, which displayed a papillary pattern in one case and a micropapillary pattern in three others. All ten HPV-associated carcinomas displayed block positive p16 and wild-type p53 by immunohistochemistry, with nine of them confirmed by HPV testing. Two of the four gastric-type adenocarcinomas had mutation-type p53, one of which also being p16 block positive. HER2 overexpression was demonstrated in 3/14 (21.4%) cases (2 HPV-associated and 1 HPV-independent). PD-L1 expression was identified in 4/10 (40%) cases, all HPV-associated. Targeted next-generation sequencing was performed in two cases with a micropapillary pattern, revealing a missense variant in ATM in an HPV-associated tumor and missense variants in TP53 and SMARCB1 in an HPV-independent tumor. The results demonstrated that primary endocervical adenocarcinomas can mimic the appearance of serous carcinoma, while not representing serous carcinoma. Serous-like papillary and micropapillary patterns may be present in both HPV-associated and HPV-independent cervical carcinomas, but none of the cases studied were unequivocally serous upon detailed analysis. Our findings support the exclusion of "cervical serous carcinoma" from existing classifications of cervical adenocarcinoma.
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Affiliation(s)
- Richard Wing-Cheuk Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. .,Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Joshua Hoi Yan Ng
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kam Chu Han
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Yuen Ping Leung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Chiu Man Shek
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kin Nam Cheung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Carmen Ka Man Choi
- Department of Obstetrics & Gynecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Ka Yu Tse
- Department of Obstetrics & Gynecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Philip P C Ip
- Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong
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Abstract
Modern classification schemes divide cervical adenocarcinomas into human papillomavirus (HPV)-associated and HPV-independent types. The precursor lesions of the former are well known and comprise HPV-associated (usual/endocervical) adenocarcinoma in situ (AIS) and the much less common stratified mucin-producing intraepithelial lesion (SMILE). The precursor lesions of HPV-independent cervical adenocarcinomas are much less well known, although postulated precursors of gastric-type adenocarcinoma include atypical lobular endocervical glandular hyperplasia and gastric-type AIS. In this review, we cover HPV-associated and HPV-independent precursor lesions of cervical adenocarcinomas concentrating on diagnostic criteria (morphology and immunophenotype) and differential diagnosis. We propose a uniform terminology and diagnostic criteria for precursor lesions showing intestinal differentiation with goblet cells because this may be a feature of both HPV-associated and HPV-independent AIS.
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A Comprehensive Review of Biomarker Use in the Gynecologic Tract Including Differential Diagnoses and Diagnostic Pitfalls. Adv Anat Pathol 2020; 27:164-192. [PMID: 31149908 DOI: 10.1097/pap.0000000000000238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Morphologic (ie, hematoxylin and eosin) evaluation of the Mullerian tract remains the gold standard for diagnostic evaluation; nevertheless, ancillary/biomarker studies are increasingly utilized in daily practice to assist in the subclassification of gynecologic lesions and tumors. The most frequently utilized "biomarker" technique is immunohistochemistry; however, in situ hybridization (chromogenic and fluorescence), chromosomal evaluation, and molecular analysis can also be utilized to aid in diagnosis. This review focuses on the use of immunohistochemistry in the Mullerian tract, and discusses common antibody panels, sensitivity and specificity of specific antibodies, and points out potential diagnostic pitfalls when using such antibodies.
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Hartsough EM, Erickson BK, Chauhan A, Khalifa MA. Isolated metastatic pancreatic adenocarcinoma to the uterine cervix: A case report. Gynecol Oncol Rep 2019; 29:61-63. [PMID: 31334322 PMCID: PMC6620713 DOI: 10.1016/j.gore.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022] Open
Abstract
The uterine cervix is an uncommon site of metastatic cancer. Specifically, pancreatic adenocarcinoma metastatic to the cervix is an exceptionally rarely reported phenomenon. We encountered a case of recurrent pancreatic adenocarcinoma presenting as a solitary metastasis to the cervix. To our knowledge, this is the only report describing an isolated recurrence of pancreatic adenocarcinoma to the cervix. When diagnosing metastatic disease to the cervix, it is also imperative for the clinician and pathologist to consider histologic mimics, such as the newly described gastric-type mucinous endocervical adenocarcinoma. Metastatic disease to the cervix may benefit from surgical resection. Pancreatic adenocarcinoma may recur as a solitary metastasis to the cervix. Metastatic adenocarcinoma to the cervix may be amenable to surgical resection. Gastric-type mucinous endocervical adenocarcinoma is a notable histologic mimic.
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Affiliation(s)
- Emily M Hartsough
- Department of Laboratory Medicine and Pathology, University of Minnesota, United States of America
| | - Britt K Erickson
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, United States of America
| | - Anil Chauhan
- Department of Radiology, University of Minnesota, United States of America
| | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, United States of America
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Virk H, Gupta P, Rai B, Rajwanshi A. Cervical cytology in a woman with abdominal distension. Cytopathology 2019; 31:65-67. [PMID: 31220388 DOI: 10.1111/cyt.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Harpreet Virk
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Stewart CJR, Crum CP, McCluggage WG, Park KJ, Rutgers JK, Oliva E, Malpica A, Parkash V, Matias-Guiu X, Ronnett BM. Guidelines to Aid in the Distinction of Endometrial and Endocervical Carcinomas, and the Distinction of Independent Primary Carcinomas of the Endometrium and Adnexa From Metastatic Spread Between These and Other Sites. Int J Gynecol Pathol 2019; 38 Suppl 1:S75-S92. [PMID: 30550485 PMCID: PMC6296834 DOI: 10.1097/pgp.0000000000000553] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In most cases of suspected endometrial neoplasia tumor origin can be correctly assigned according to a combination of clinical, radiologic, and pathologic features, even when the latter are based upon the examination of relatively small biopsy samples. However there are well-recognized exceptions to this rule which continue to create diagnostic difficulty, and sometimes difficulties persist even after the detailed examination of resection specimens. Among the most common problems encountered in practice are the distinction of primary endometrial and primary endocervical adenocarcinomas, and the determination of tumor origin when there is synchronous, multifocal involvement of gynecologic tract sites, for example the endometrium and the ovary. However, accurate diagnosis in these cases is important because this has significant staging, management and prognostic implications. In this review we discuss the value and limitations of key morphologic, immunophenotypic and molecular findings in these diagnostic scenarios.
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Affiliation(s)
- Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital and School for Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia (C.J.R.S.) Department of Pathology, Brigham and Women's Hospital (C.P.C.) Department of Pathology, Massachusetts General Hospital and Harvard Medical School (E.O.), Boston, Massachusetts Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK (W.G.M.) Department of Pathology, Memorial-Sloan Kettering Cancer Center, New York, New York (K.J.P.) Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (J.K.R.) Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.) Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (V.P.) Pathological Oncology Group and Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain (X.M.-G.) Departments of Pathology and Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland (B.M.R.)
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Hodgson A, Park KJ, Djordjevic B, Howitt B, Nucci MR, Oliva E, Stolnicu S, Xu B, Soslow RA, Parra-Herran C. International Endocervical Adenocarcinoma Criteria and Classification: Validation and Interobserver Reproducibility. Am J Surg Pathol 2019; 43:75-83. [PMID: 29877920 PMCID: PMC6281796 DOI: 10.1097/pas.0000000000001095] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current World Health Organization (WHO) classification for endocervical adenocarcinoma (EA) is based on descriptive morphologic characteristics; however, it does not fully reflect our current knowledge of the diverse pathogenesis of cervical glandular neoplasia. A novel classification system, the International Endocervical Adenocarcinoma Criteria and Classification (IECC), which incorporates etiology and biological behavior into the morphologic scheme, has been recently proposed. We aimed to validate the IECC by assessing its interobserver reproducibility in comparison to the WHO system. A cohort of 75 EAs was reviewed independently by 7 gynecologic pathologists and categorized following IECC and WHO criteria based on hematoxylin and eosin material alone and after immunohistochemistry results for p16, PR, p53, Napsin-A, vimentin, CDX2, and GATA3 were provided. Human papillomavirus (HPV) in situ hybridization and polymerase chain reaction results were compared with consensus diagnoses. IECC was superior to WHO in terms of interobserver agreement with κ=0.46 versus 0.3, respectively, on hematoxylin and eosin review and κ=0.51 versus 0.33, respectively, with immunohistochemistry. Under the IECC, 73 (97%) of EAs had majority agreement (≥4 reviewers in agreement) whereas 42 (56%) had perfect agreement (7/7 reviewers in agreement). Conversely, WHO showed majority agreement in 56 (75%) and perfect agreement in only 7 (10%) EAs. Reproducibility was poor in HPV-related WHO types (usual κ=0.36, mucinous not otherwise specified κ=0.13, intestinal κ=0.31, villoglandular κ=0.21) and good in major HPV-unrelated categories (gastric type κ=0.63, clear cell κ=0.81, mesonephric κ=0.5). Classification as per the IECC had excellent correlation with HPV status (by RNA in situ hybridization or polymerase chain reaction). We have shown that the IECC has superior interobserver agreement compared with the WHO classification system, and that distinction between HPV-related and HPV-unrelated EA can be made with good reproducibility and excellent prediction of HPV status. WHO morphologic variants of HPV-related EA are poorly reproducible. Conversely, agreement is high among important high-risk HPV-unrelated subtypes. Thus, our results further support replacing the current WHO classification with the IECC.
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Affiliation(s)
- Anjelica Hodgson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kay J. Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bojana Djordjevic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brooke Howitt
- Department of Pathology, Stanford Medical Centre – Stanford University School of Medicine, Stanford, California
| | - Marisa R. Nucci
- Department of Pathology, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA, United States
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, United States
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Bin Xu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
We report an unusual case of uterine corpus metastasis from rectal adenocarcinoma detected using F-FDG PET/CT. A 47-year-old woman was diagnosed with rectal adenocarcinoma and treated with surgery and radiochemotherapy 3 years ago. During follow-up, she presented with lower abdomen pain and elevated tumor markers, but ultrasonography findings were unremarkable. We performed an F-FDG PET/CT scan, which showed intense F-FDG avidity in the myometrium of the uterine corpus. Uterine corpus metastasis was suspected, and complementary MRI and diagnostic curettage histopathology confirmed uterine metastasis from rectal adenocarcinoma.
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14
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Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, Aviel-Ronen S, Kiyokawa T, Alvarado-Cabrero I, Pike MC, Oliva E, Park KJ, Soslow RA. International Endocervical Adenocarcinoma Criteria and Classification (IECC): A New Pathogenetic Classification for Invasive Adenocarcinomas of the Endocervix. Am J Surg Pathol 2018; 42:214-226. [PMID: 29135516 PMCID: PMC5762258 DOI: 10.1097/pas.0000000000000986] [Citation(s) in RCA: 221] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We sought to classify endocervical adenocarcinomas (ECAs) based on morphologic features linked to etiology (ie, human papillomavirus [HPV] infection), unlike the World Health Organization 2014 classification. The International Endocervical Adenocarcinoma Criteria and Classification (IECC criteria), described herein, distinguishes between human papillomavirus-associated adenocarcinoma (HPVA), recognized by the presence of luminal mitoses and apoptosis seen at scanning magnification, and no or limited HPVA features (nonhuman papillomavirus-associated adenocarcinoma [NHPVA]). HPVAs were then subcategorized based on cytoplasmic features (mostly to provide continuity with preexisting classification schemes), whereas NHPVAs were subclassified based on established criteria (ie, gastric-type, clear cell, etc.). Complete slide sets from 409 cases were collected from 7 institutions worldwide. Tissue microarrays representing 297 cases were constructed; immunohistochemistry (p16, p53, vimentin, progesterone receptor) and chromogenic in situ hybridization using an RNA-based probe set that recognizes 18 varieties of high-risk HPV were performed to validate IECC diagnoses. The 5 most common IECC diagnoses were usual-type (HPVA) (73% of cohort), gastric-type (NHPVA) (10%), mucinous adenocarcinoma of HPVA type, including intestinal, mucinous not otherwise specified, signet-ring, and invasive stratified mucin-producing carcinoma categories (9%), clear cell carcinoma (NHPVA) (3%) and adenocarcinoma, not otherwise specified (2%). Only 3 endometrioid carcinomas were recognized and all were NHPVA. When excluding cases thought to have suboptimal tissue processing, 90% and 95% of usual-type IECC cases overexpressed p16 and were HPV, whereas 37% and 3% of NHPVAs were p16 and HPV, respectively. The 1 HPV gastric-type carcinoma was found to have hybrid HPVA/NHPVA features on secondary review. NHPVA tumors were larger and occurred in significantly older patients, compared with HPVA tumors (P<0.001). The high-risk HPV chromogenic in situ hybridization probe set had superior sensitivity, specificity, and positive and negative predictive values (0.955, 0.968, 0.992, 0.833, respectively) compared with p16 immunohistochemistry (0.872, 0.632, 0.907, 0.545, respectively) to identify HPV-related usual carcinoma and mucinous carcinoma. IECC reliably segregates ECAs into HPVA and NHPVA types using morphology alone. This study confirms that usual-type ECAs are the most common type worldwide and that mucinous carcinomas comprise a mixture of HPVA and NHPVA, with gastric-type carcinoma being the major NHPVA type. Endometrioid and serous carcinomas of the endocervix are extraordinarily rare. Should clinical outcomes and genomic studies continue to support these findings, we recommend replacement of the World Health Organization 2014 criteria with the IECC 2017.
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Affiliation(s)
- Simona Stolnicu
- University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Iulia Barsan
- University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Lien Hoang
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Prusha Patel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anna Pesci
- Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | | | | | | | - Kay J. Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Zamora Guerra Y, Córdova Ramírez S. Cytological diagnosis of cervical adenocarcinoma and cytohistological agreement at General Hospital of Mexico “Dr. Eduardo Liceaga”. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Stewart CJR, Koay MHE, Leslie C, Acott N, Leung YC. Cervical carcinomas with a micropapillary component: a clinicopathological study of eight cases. Histopathology 2017; 72:626-633. [PMID: 29034552 DOI: 10.1111/his.13419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
AIMS Micropapillary carcinomas, or carcinomas with a micropapillary component, are well recognised in the breast and other anatomical sites. However, they have seldom been described in the cervix. In this article, we present a clinicopathological analysis of eight cervical tumours that showed at least a focal (≥5%) component of micropapillary carcinoma. METHODS AND RESULTS The study group comprised eight cervical carcinomas (four adenocarcinomas and four adenosquamous carcinomas) with a micropapillary component. The median patient age was 41.5 years (range 27-65 years). At presentation, five patients were stage IB, two were stage IIB, and one was stage IV. The micropapillary component accounted for ≤25% of the tumour on initial biopsy or resection specimens in all but one case. Immunohistochemistry showed 'inside-out' (reverse polarity) mucin 1 staining along the cell membrane abutting the stroma. Four patients developed metastasis, all of whom showed a pure micropapillary pattern; this led to a misdiagnosis of an apparently independent peritoneal serous carcinoma in one case. All tumours showed diffuse p16 expression, and all three cases that were tested were positive for human papillomavirus (HPV) 18. Three of the six patients with at least 12 months of follow-up died of disease, and one is alive with distant metastasis. CONCLUSIONS Usual-type (HPV-related) cervical carcinomas may show micropapillary differentiation, usually as a focal finding, and the cells show reverse polarity like similar tumours arising in other sites. Micropapillary cervical carcinoma appears to be a clinically aggressive malignancy, although this needs to be confirmed in larger studies.
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Affiliation(s)
- Colin J R Stewart
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia.,School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Mei H E Koay
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia
| | - Connull Leslie
- Division of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Nathan Acott
- Division of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Yee C Leung
- School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.,Department of Gynaecological Oncology, King Edward Memorial Hospital, Perth, WA, Australia
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17
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Hannouf MB, Winquist E, Mahmud SM, Brackstone M, Sarma S, Rodrigues G, Rogan PK, Hoch JS, Zaric GS. The clinical significance of occult gynecologic primary tumours in metastatic cancer. Curr Oncol 2017; 24:e368-e378. [PMID: 29089807 DOI: 10.3747/co.24.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). METHODS We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002-2011. We defined patients as having an "occult" primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have "obvious" primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. RESULTS Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. CONCLUSIONS In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.
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Affiliation(s)
- M B Hannouf
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Ivey Business School, Western University, London, ON
| | - E Winquist
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - S M Mahmud
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - M Brackstone
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - S Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - G Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Radiation Oncology, London Regional Cancer Program, London, ON
| | - P K Rogan
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - J S Hoch
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.,Department of Public Health Sciences, University of California, Davis, CA, U.S.A
| | - G S Zaric
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Ivey Business School, Western University, London, ON
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18
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Kinoshita Y, Yoshizawa K, Yuri T, Tsubur A, Shikata N. Endocervical metastasis of pancreatic cancer: A rare case report of long-term survival. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Afrogheh AH, Meserve E, Sadow PM, Stephen AE, Nosé V, Berlin S, Faquin WC. Molecular Characterization of an Endometrial Endometrioid Adenocarcinoma Metastatic to a Thyroid Hürthle Cell Adenoma Showing Cancerization of Follicles. Endocr Pathol 2016; 27:213-9. [PMID: 26687112 DOI: 10.1007/s12022-015-9412-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tumor-to-tumor metastasis is rare. Herein, we present a unique case of endometrial endometrioid adenocarcinoma metastatic to a thyroid Hürthle cell adenoma 9 years after initial diagnosis. On histologic examination of the thyroid, the malignant endometrioid glands and single cells (donor tumor) were dispersed within the Hürthle cell adenoma (recipient tumor). In several sections of the adenoma with still preserved microfollicular architecture, malignant endometrial adenocarcinoma cells were admixed within oncocytic adenomatous epithelium (so-called "cancerization of the follicles"). This unusual phenomenon, to our knowledge, is a novel finding in the thyroid gland. Immunohistochemistry, subsequently elicited clinical history, and morphologic comparison of the tumor in the thyroid to the primary endometrial tumor confirmed the origin of the donor tumor cells. Molecular analysis of both the metastatic and primary endometrial tumors demonstrated PIK3CA and PTEN mutations in both tumors, as is characteristic of well-differentiated endometrioid tumors of the endometrium. Amplification of chromosome 1q was detected in both sites; however, only the metastatic tumor showed loss of chromosomes 2, 9, and 22. The morphologic differential diagnosis of metastatic endometrioid adenocarcinoma in the thyroid includes columnar cell variant of papillary thyroid carcinoma (CCVPTC) arising in a preexisting adenoma, endocrine glandular atypia within an adenoma, and metastasis from other anatomic sites. Histomorphologic differences among these entities may be subtle; therefore, knowledge of and morphologic comparison with prior malignancies and immunohistochemistry can be helpful in rendering the correct diagnosis.
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Affiliation(s)
- Amir H Afrogheh
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Emily Meserve
- Department of Pathology, Brigham & Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Antonia E Stephen
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Vânia Nosé
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Suzanne Berlin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02114, USA.
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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20
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Abstract
FDG avid uterine cervical masses are most commonly due to primary cervical carcinoma; however, history and differential diagnoses are critical when interpreting FDG PET/CT studies. A 51-year-old woman with newly diagnosed moderately differentiated adenocarcinoma of the rectum underwent FDG PET/CT for staging, which revealed the hypermetabolic primary rectal tumor and nodal metastases. Additionally, FDG avid focus in the anterior cervix without a CT correlate was present. Cervical metastasis was suspected, and further evaluation with MRI and histopathologic correlation was recommended, which confirmed cervical metastasis. This case illustrates an unusual case of FDG-avid cervical metastasis from rectal adenocarcinoma.
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21
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Toyoshima M, Momono Y, Makino H, Kudo T, Oka N, Sakurada J, Suzuki H, Kodama H, Yoshinaga K. Cytokeratin 7-positive/cytokeratin 20-negative cecal adenocarcinoma metastatic to the uterine cervix: a case report. World J Surg Oncol 2016; 14:22. [PMID: 26810414 PMCID: PMC4727413 DOI: 10.1186/s12957-016-0774-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Background The vast majority of uterine cervical malignancies are primary carcinomas, and secondary neoplasms that metastasize to the uterine cervix from a distant organ are uncommon. Although relatively rare, metastases to the uterine cervix from a primary colon cancer have been reported. We report a rare case of metastatic carcinoma originating from a cecal adenocarcinoma with an unusual cytokeratin 7/cytokeratin 20 immunophenotype. Case presentation A 74-year-old postmenopausal Japanese woman was referred to our hospital for the evaluation of a uterine tumor. She had a past medical history of cecal cancer and had undergone laparoscopically assisted right hemicolectomy at the age of 69 years. During follow-up, she was found to have elevated levels of the tumor markers carbohydrate antigen 19-9 (179.7 IU/mL) and carcinoembryonic antigen (26.9 μg/L). Positron emission tomography/computed tomography showed a focus of high 18F-fluorodeoxyglucose uptake in her uterus. Examination of a cervical biopsy found a poorly differentiated adenocarcinoma that was immunopositive for cytokeratin (CK)7 and caudal-related homeobox 2 (CDX2) expression and immunonegative for cytokeratin 20 expression. The patient underwent radical hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination found invasive growth of irregular and atypical ductal hyperplasia. Immunohistochemical staining of the tumor specimen revealed the same immunophenotype as the biopsy specimen. The cecal cancer specimen from her previous surgery was also examined and found to have the same immunophenotype. The histopathological diagnosis was cecal adenocarcinoma metastatic to the uterine cervix. The patient is currently receiving adjuvant chemotherapy and to date is without evidence of recurrent disease. Conclusions Our report illustrates the importance of immunohistochemistry for the correct diagnosis of the origin of a uterine cervical adenocarcinoma in a patient with a medical history of colorectal cancer. Re-examination of a previous oncological specimen is critical for cases with a uterine lesion that is difficult to identify as primary or metastatic cancer.
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Affiliation(s)
- Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, Sendai, Japan. .,Present address: Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Yuta Momono
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Hiromitsu Makino
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Takako Kudo
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Naomi Oka
- Department of Pathology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Junko Sakurada
- Department of Pathology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Hiroyoshi Suzuki
- Department of Pathology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Hideaki Kodama
- Department of Surgery, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
| | - Kosuke Yoshinaga
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, Sendai, Japan.
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Endometrial involvement in pseudomyxoma peritonei secondary to low-grade appendiceal mucinous neoplasm: report of 2 cases. Int J Gynecol Pathol 2016; 34:232-8. [PMID: 25760906 DOI: 10.1097/pgp.0000000000000149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pseudomyxoma peritonei is a clinical condition characterized by the presence of mucinous ascites, usually with variable amounts of neoplastic enteric-type mucinous epithelium, and most commonly secondary to spread from a low-grade appendiceal mucinous neoplasm. We report 2 cases of pseudomyxoma peritonei associated with low-grade appendiceal mucinous neoplasms where there was colonization of the endometrium (both cases) and cervical mucosa (1 case) by low-grade atypical enteric-type mucinous epithelium (CK20 positive and CK7 negative). The patients had symptoms of mucoid vaginal discharge and endometrial biopsies in both (1 patient had multiple endometrial biopsies over a period of 11 mo) and were initially interpreted as representing mucinous metaplasia. Pseudomyxoma peritonei may rarely result in endometrial and cervical mucosal involvement, presumably secondary to transtubal spread.
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24
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GATA3 Is a Sensitive and Specific Marker of Benign and Malignant Mesonephric Lesions in the Lower Female Genital Tract. Am J Surg Pathol 2015; 39:1411-9. [PMID: 26135559 DOI: 10.1097/pas.0000000000000471] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
GATA3 is a transcription factor critical for embryogenesis, development, and cell differentiation. Recent studies have suggested that GATA3 is a sensitive and relatively specific biomarker for urothelial and breast carcinomas, with most Müllerian carcinomas being negative. We investigated GATA3 expression in mesonephric/Wolffian remnants and tumors in the female genital tract. A western blot was performed to assess specificity for the GATA3 antibody. GATA3 immunohistochemistry was performed on 59 formalin-fixed paraffin-embedded mesonephric samples, including 17 mesonephric remnants (MR; 11 cervical and 6 fallopian tube), 15 mesonephric hyperplasias, 21 mesonephric carcinomas, and 6 female adnexal tumors of probable Wolffian origin. Thirty conventional endocervical adenocarcinomas (ENDO-CA), 9 gastric-type cervical adenocarcinomas, and 165 endometrial adenocarcinomas (EM-CA) were also evaluated. GATA3 nuclear intensity and extent of staining was evaluated. The western blot revealed GATA3 expression in seminal vesicle and cell lines derived from breast and urothelial carcinomas, but not in other cell lines including ovarian, cervical, and endometrial cancers. All cervical MRs and mesonephric hyperplasias, 5/6 (83%) fallopian tube MRs, and 20/21 (95%) mesonephric carcinomas were GATA3 positive, although with great variability in both intensity (weak to strong) and extent (1+ to 3+) of staining. Only 1/6 (17%) female adnexal tumors of probable Wolffian origin showed weak multifocal staining. One of 30 (3%) usual-type ENDO-CAs and 3/165 EM-CAs exhibited weak-moderate GATA3 immunoreactivity; all gastric-type cervical adenocarcinomas were negative. GATA3 is a highly sensitive and specific marker for mesonephric lesions in the lower genital tract; however, its utility in the upper genital tract may be more limited. In addition, GATA3 can aid in distinguishing lower genital mesonephric lesions from usual-type and gastric-type ENDO-CAs and uterine EM-CAs.
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25
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Zaheer A, Wadhwa V, Oh J, Fishman EK. Pearls and pitfalls of imaging metastatic disease from pancreatic adenocarcinoma: a systematic review. Clin Imaging 2015; 39:750-8. [PMID: 25981735 DOI: 10.1016/j.clinimag.2015.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 12/12/2022]
Abstract
Pancreatic adenocarcinoma is a systemic disease due to the presence of metastatic disease at the time of diagnosis and local recurrence as well as distant metastatic disease after treatment in a majority of patients. Recognition of these metastatic sites may help in accurate staging and assessment of therapeutic response. The authors discuss and illustrate imaging findings of metastatic disease from pancreatic adenocarcinoma in different organ systems with emphasis on entities that can mimic metastatic pancreatic cancer.
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Affiliation(s)
- Atif Zaheer
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231; Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD 21231.
| | - Vibhor Wadhwa
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231
| | - Joseph Oh
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231
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26
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Waks AG, Lennon J, Yadav BS, Hwang H, dSchapirael Carmen M, Johnson NB, Reynolds K, Schapira L, Gilman PB, Overmoyer B. Metastasis to the Cervix Uteri 15 Years After Treatment of Lobular Carcinoma of the Breast. Semin Oncol 2015; 42:e81-94. [DOI: 10.1053/j.seminoncol.2015.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Rabban JT, Vohra P, Zaloudek CJ. Nongynecologic Metastases to Fallopian Tube Mucosa. Am J Surg Pathol 2015; 39:35-51. [DOI: 10.1097/pas.0000000000000293] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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28
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Gupta N, Bhar V, Dey P, Rajwanshi A, Suri V. Direct sampling of metastatic ovarian carcinoma masquerading as endocervical adenocarcinoma in liquid-based cytology cervical sample. J Cytol 2014; 31:165-7. [PMID: 25538388 PMCID: PMC4274530 DOI: 10.4103/0970-9371.145654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cervical sample is routinely taken to identify squamous dysplastic lesions of the cervix. Glandular lesions are far less commonly reported on cervical samples. The most common glandular lesion reported on cervical smear is endocervical adenocarcinoma, followed by endometrial adenocarcinoma. Direct sampling by Cervex brush is possible even in endometrial adenocarcinoma, if the tumor directly involves lower uterine segment/endocervical canal. Metastases to cervix are rare but have occasionally been reported in previous reports. We wish to highlight in this case, metastatic ovarian carcinoma directly sampled in cervical liquid-based cytology (LBC) sample, which mimicked cytomorphologically a well-differentiated endocervical adenocarcinoma. To the best of our knowledge, a similar case has not been previously published in SurePath LBC sample.
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikrant Bhar
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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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31
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Euscher E, Malpica A. Use of immunohistochemistry in the diagnosis of miscellaneous and metastatic tumors of the uterine corpus and cervix. Semin Diagn Pathol 2014; 31:233-57. [PMID: 24863030 DOI: 10.1053/j.semdp.2014.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Uncommon tumors in the uterus present diagnostic challenges. In some cases, the tumor subtype is usually seen outside the gynecologic tract and the possibility of a uterine primary is not considered. In other cases, histologic overlap with more common uterine tumors leads to potential misdiagnosis. Finally, metastatic carcinoma may involve the uterus and cervix. Rarely, symptoms related to the uterine metastasis may precede diagnosis of an extrauterine primary. Without the proper clinical context, the possibility of a missed diagnosis is increased. One must first be aware of these possibilities, but immunoperoxidase studies are often necessary to confirm the diagnosis. In this review, unusual and metastatic tumors involving the uterine corpus and cervix and immunoperoxidase studies used to diagnosis such tumors are discussed.
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Affiliation(s)
- Elizabeth Euscher
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, Texas 77030.
| | - Anais Malpica
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, Texas 77030
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32
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Tambouret R. Female genital tract. Cancer Treat Res 2014; 160:241-272. [PMID: 24092373 DOI: 10.1007/978-3-642-38850-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rosemary Tambouret
- Department of Pathology, Massachusetts General Hospital, Warren 105/55 Fruit Street, Boston, MA, 02114, USA,
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Zannoni GF, Vellone VG, Petrillo M, Fadda G, Rossi ED, Scambia G, Carbone A. Secondary malignancies of the uterine cervix: a potential diagnostic pitfall. Virchows Arch 2013; 463:23-9. [DOI: 10.1007/s00428-013-1436-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/09/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
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Abstract
McCluggage W G (2012) Histopathology New developments in endocervical glandular lesions There is evidence that the prevalence of premalignant and malignant endocervical glandular lesions is increasing in real as well as in apparent terms. In this review, new developments and selected controversial aspects of endocervical glandular lesions are covered, concentrating mainly on premalignant and malignant lesions. The terminology of premalignant endocervical glandular lesions is discussed with a comparison of the World Health Organization classification and the cervical glandular intraepithelial neoplasia (CGIN) system, which is in widespread use in the United Kingdom. Primary cervical adenocarcinomas comprise a heterogeneous group of different morphological types, and while it is known that the majority of these are associated with high-risk human papillomavirus (HPV), it has become clear in recent years that most of the more uncommon morphological types are unassociated with HPV, although they may sometimes be p16-positive. A spectrum of benign, premalignant and malignant cervical glandular lesions exhibiting gastric differentiation is now recognized; these include type A tunnel clusters, typical and atypical lobular endocervical glandular hyperplasia, adenoma malignum and gastric-type adenocarcinoma. The latter is a recently described variant of primary cervical adenocarcinoma which has a different morphological appearance to the usual endocervical type and which is probably associated with different patterns of spread and a worse prognosis. There is accumulating evidence that 'early invasive' cervical adenocarcinomas have an excellent prognosis and are suitable for conservative management. Immunohistochemical markers of value in the distinction between a primary cervical and endometrial adenocarcinoma are discussed. While it is well known that a panel of markers comprising oestrogen receptor (ER), vimentin, p16 and monoclonal carcinoembryonic antigen (CEA) is useful, several major pitfalls are pointed out and this panel of markers is predominantly of value in 'low-grade' adenocarcinomas. A related group of lesions, including cervical ectopic prostatic tissue and vaginal tubulosquamous polyp, are probably derived from para-urethral Skene's glands and may be positive with prostatic markers. Recent developments in cervical neuroendocrine neoplasms are discussed, as these are associated not uncommonly with a premalignant or malignant endocervical glandular lesion.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK.
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Stewart CJR, Leung YC, Whitehouse A. Fallopian tube metastases of non-gynaecological origin: a series of 20 cases emphasizing patterns of involvement including intra-epithelial spread. Histopathology 2012; 60:E106-14. [DOI: 10.1111/j.1365-2559.2012.04194.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Roma AA. Metastatic gastric adenocarcinoma primarily presenting in the fallopian tube. Ann Diagn Pathol 2012; 16:63-6. [DOI: 10.1016/j.anndiagpath.2010.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/12/2010] [Accepted: 12/01/2010] [Indexed: 11/16/2022]
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Ovarian Low-grade Serous Carcinoma Involving the Cervix Mimicking a Cervical Primary. Int J Gynecol Pathol 2011; 30:613-9. [DOI: 10.1097/pgp.0b013e318217137e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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PAX8 expression reliably distinguishes pancreatic well-differentiated neuroendocrine tumors from ileal and pulmonary well-differentiated neuroendocrine tumors and pancreatic acinar cell carcinoma. Mod Pathol 2011; 24:412-24. [PMID: 20890270 DOI: 10.1038/modpathol.2010.176] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PAX (paired box) genes encode a family of transcription factors that regulate organogenesis in a variety of organs. Very little is known about the role of PAX8 in endocrine cell development and the expression of PAX8 in neuroendocrine tumors. The purpose of this study was to analyze PAX8 immunohistochemical expression in gastroenteropancreatic and pulmonary well-differentiated neuroendocrine tumors to determine whether PAX8 can reliably distinguish pancreatic neuroendocrine tumors from neuroendocrine tumors of other anatomic sites and other pancreatic non-ductal neoplasms. In total, 221 well-differentiated neuroendocrine tumors were evaluated: 174 primary neuroendocrine tumors (66 pancreatic, 31 ileal, 21 pulmonary, 20 gastric, 17 rectal, 11 appendiceal, and 8 duodenal) and 47 neuroendocrine tumors metastatic to the liver (31 pancreatic, 11 ileal, 2 pulmonary, 2 duodenal, and 1 rectal). Fifteen solid-pseudopapillary neoplasms and six acinar cell carcinomas of the pancreas were also evaluated. PAX8 was positive in 49/66 (74%) primary pancreatic neuroendocrine tumors. PAX8 expression did not correlate with World Health Organization categorization, grade, size, functional status, or the presence of liver or lymph node metastasis. PAX8 expression was identified in 0/31 (0%) ileal, 0/21 (0%) pulmonary, 2/20 (10%) gastric, 5/17 (29%) rectal, 1/11 (9%) appendiceal, and 6/8 (75%) duodenal neuroendocrine tumors. PAX8 was positive in 4/15 (27%) solid-pseudopapillary neoplasms of the pancreas, whereas all acinar cell carcinomas (0/6) lacked immunoreactivity. Among liver metastases, only pancreatic neuroendocrine tumors (20/31, 65%) were PAX8 positive, whereas no cases of ileal (0/11), pulmonary (0/2), duodenal (0/2), and rectal (0/1) neuroendocrine tumor metastases were PAX8 positive. PAX8 is expressed in primary and metastatic pancreatic well-differentiated neuroendocrine tumors, and its expression can reliably distinguish pancreatic from ileal and pulmonary well-differentiated neuroendocrine tumors. Duodenal neuroendocrine tumors and a subset of rectal, gastric, and appendiceal neuroendocrine tumors may also express PAX8. PAX8 expression can distinguish pancreatic neuroendocrine tumors from acinar cell carcinomas, but its utility in distinguishing neuroendocrine tumors from solid-pseudopapillary neoplasms is limited.
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