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Koh HH, Kim H, Park S, Do SI, Kim HS. Invasive Micropapillary Carcinoma of the Uterine Cervix. Case Rep Oncol 2020; 13:1446-1453. [PMID: 33442369 PMCID: PMC7772833 DOI: 10.1159/000510744] [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: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
We herein present a case of uterine cervical invasive micropapillary carcinoma (IMPC) in a 35-year-old woman. She had neither specific symptoms nor any previous gynecological history. A cervical punch biopsy revealed a high-grade squamous intraepithelial lesion and concurrent intestinal-type mucinous carcinoma. Based on the preoperative diagnosis of endocervical adenocarcinoma, she underwent radical hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection. Grossly, there was an ovoid, slightly elevated mass with surface nodularity in the lower endocervix, measuring 10 × 8 mm. Histologically, the tumor consisted predominantly of tufts of tumor cells arranged in micropapillary structures devoid of fibrovascular cores and surrounded by clear, empty, lacunar spaces between tumor cell nests and stroma. The IMPC component comprised 90% of the entire tumor volume. The greatest dimension and stromal invasion depth of the IMPC were 8 and 3 mm, respectively (FIGO stage IA2). Immunostaining revealed that mucin 1 (MUC1) surrounded each micropapillary structure, indicating the reverse epithelial polarity of the glandular cells. MUC1 was localized predominantly in the stroma-facing surface of the cell clusters, accentuating the outlines of the micropapillary structures by forming a distinct, characteristic band on this surface. In addition, targeted sequencing analysis of the IMPC revealed a missense PIK3CA mutation (c.1633G>A). In summary, we present the clinicopathological characteristics of cervical IMPC. We demonstrate for the first time that IMPC of the uterine cervix harbors a pathogenic missense mutation in PIK3CA. Further investigations using larger cohorts of patients are necessary to confirm these findings.
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Affiliation(s)
- Hyun Hee Koh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunjin Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sujin Park
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Im Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abstract
Micropapillary adenocarcinoma has been reported as an aggressive variant of adenocarcinoma in several organs, where it is associated with poor clinical outcome. This study reports the clinicopathologic features and outcomes of cervical adenocarcinomas with a micropapillary component (micropapillary cervical adenocarcinomas); this represents the largest reported study of these neoplasms. The study comprised 44 cervical adenocarcinomas of usual (human papillomavirus-related)-type (84%), mucinous, not otherwise specified (4.5%), gastric-type (4.5%), endometrioid (4.5%), and adenosquamous carcinoma (2%). The micropapillary component comprised >50% of the neoplasm in 34 cases (77%) (group 1), and 10% to 50% in 10 cases (23%) (group 2). Lymph node metastasis was present in 41 of 44 (93%) cases and typically the nodal tumor retained a prominent micropapillary morphology. Follow-up ranged from 7 to 123 months (mean, 65.9 mo). Seventeen of 44 (38.6%) patients had no evidence of disease on follow-up, 6/44 (13.6%) were alive with disease, and 21/44 (47.7%) died of disease. There were no survival differences between group 1 and group 2. On univariate analysis, lymph node metastasis (P=0.0015), lymphovascular space invasion (P=0.002), parametrial involvement (P=0.03), and depth of stromal invasion (P=0.045) were related to tumor recurrence. On multivariate analysis, lymph node metastasis (P=0.001), and extent of lymphovascular space invasion (P=0.027) were significant independent predictors of tumor recurrence. Our study shows that a micropapillary component in cervical adenocarcinoma may be associated with aggressive behavior and that a micropapillary architecture may occur within a variety of types of cervical adenocarcinoma.
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Cardiac Tamponade as an Initial Manifestation of Cervical Cancer. Case Rep Oncol Med 2019; 2019:7524797. [PMID: 30729054 PMCID: PMC6343150 DOI: 10.1155/2019/7524797] [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] [Received: 10/09/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022] Open
Abstract
Cervical cancer is the second most common malignancy worldwide in women and the third most common cause of cancer death in developing countries. This type of cancer spreads mainly to the lung, the bone, and the brain; however, the pericardium is an unusual site of invasion, which is associated with a poor prognosis. We present a case of a 35-year-old woman with six months of leg edema and abnormal uterine bleeding. During the initial evaluation, cardiac tamponade and a bilateral pleural effusion were found. A left supraclavicular lymphadenopathy was identified on physical examination, while gynecological examination and MRI were irrelevant. Initial cytology of the pericardial fluid showed a poorly differentiated carcinoma, and a cervical biopsy revealed a squamous cell invasive carcinoma. Chemotherapy was started with carboplatin and paclitaxel, but no clinical improvement was noted and the patient died 46 days after arrival. Cardiac tamponade in a young female patient is a harbinger to widen the differential diagnosis to include not only infectious, cardiac, or metabolic etiology but also oncological causes since this will allow appropriate treatment.
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Martínez-Girón R, Pantanowitz L, Martínez-Torre S, Pantanowitz J. Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review. Respir Med Case Rep 2019; 26:185-188. [PMID: 30705816 PMCID: PMC6349302 DOI: 10.1016/j.rmcr.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/11/2019] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac death is an unexpected clinical condition that typically occurs due to a cardiac cause, generally within 1 h of symptom onset, in people with known or unknown cardiac disease. Primary malignant pericardial mesothelioma, as a cause of sudden death, is an uncommon consequence of a rare disease. Herein, we present a case of cardiac tamponade due to a primary pericardial mesothelioma. Cytological, histopathology and gross post-mortem findings, in a previously asymptomatic 46-old-year man, are reported. The medical literature regarding this topic is also reviewed.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, 33007, Oviedo, Spain
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Santiago Martínez-Torre
- Departament of Family and Community Medicine, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
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Hodgson A, Park KJ. Cervical Adenocarcinomas: A Heterogeneous Group of Tumors With Variable Etiologies and Clinical Outcomes. Arch Pathol Lab Med 2019; 143:34-46. [DOI: 10.5858/arpa.2018-0259-ra] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Cervical adenocarcinomas are a heterogeneous group of tumors with varying morphologies, etiologies, molecular drivers, and prognoses, comprising approximately 25% of all cervical cancers. Unlike cervical squamous cell carcinoma, adenocarcinomas are not uniformly caused by high-risk human papillomavirus (HPV) infection and, therefore, would not necessarily be prevented by the HPV vaccine.
Objective.—
To provide a review of endocervical adenocarcinoma subtypes and, when appropriate, discuss precursor lesions, etiologies, molecular genetics, and ancillary studies within the context of clinical care. Some historical perspectives will also be provided.
Data Sources.—
Data sources included published peer-reviewed literature and personal experiences of the senior author.
Conclusions.—
Endocervical adenocarcinomas are a histologically diverse group of tumors with various causes and molecular drivers, not all related to HPV infection. Distinguishing them has important implications for treatment and prognosis as well as strategies for prevention.
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Affiliation(s)
- Anjelica Hodgson
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Dr Hodgson); and the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Park)
| | - Kay J. Park
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Dr Hodgson); and the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Park)
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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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