Professional Documents
Culture Documents
DIAGNOSTIC PROBLEMS
IN GLANDULAR LESIONS
OF THE UTERINE CERVIX
Esther Oliva
Massachusetts General Hospital
eoliva@partners.org
Sharp transition
Hanging mitoses
APOPTOTIC BODIES
Significant correlation
between apoptotic bodies
and mitotic figures
Seen in adenocarcinoma in
situ and all types of invasive
adenocarcinoma except in
adenoma malignum
May be seen in cervical
endometriosis
Differential diagnosis with
intraepithelial lymphocytes
LOBULAR
ARCHITECTURE
ADENOCARCINOMA IN SITU:
SUBTYPES
Endocervical
Endometrioid
Tubal
Intestinal
Adenosquamous
Mucin depletion
ADENOCARCINOMA IN SITU,
INTESTINAL TYPE
PANETH CELLS
MIXED AIS
ADENOCARCINOMA IN SITU
Differential Diagnosis
S
C
C
In situ
M
I
M
I
C
K
I
N
G
A
I
S
CERVICAL ENDOMETRIOSIS
Two major categories:
- Superficial: Related to previous trauma
No association with endometriosis
elsewhere
- Deep: Associated with pelvic endometriosis
ENDOMETRIOSIS
AIS
ENDOMETRIOSIS
DIFFERENTIAL FEATURES
EMOS
AIS
Abnormal Pap smear
+
+
Endometrial stroma
+
Stromal hemorrhage
+
Nuclear pseudostratif
+
+
Mitotic figures
-/+ (also stroma) +
Apoptotic bodies
-/+
+
Squamous dysplasia
+
p16 positivity
Focal
Diffuse
TUBAL METAPLASIA
MIMICKING ADENOCARCINOMA IN SITU
TUBAL METAPLASIA
Frequent finding
More common in hysterectomy specimens than
cone biopsies
Typically in upper endocervix and deep glands
No association with other pathologic conditions
Frequent confusion with endocervical gland
neoplasia on biopsy and Pap smears
TUBAL METAPLASIA
Atypia
ENDOMETRIOID
CILIATED CARCINOMA
TUBAL-TYPE AIS
AIS
MIB 1
ProExC
p16
CEA (M)
Bcl-2
Vim
ER
PAX2
> 30%
+ (>50% cells)
+ (D)
+ (CP)
-/+ (F)
-
AIS
Ki-67
TEM/EMOS
< 10%
+ (<10% cells)
-/+ (F)
-/+ (Lum)
+
+
+ (D)
+
TEM
p16
TUBOENDOMETRIOD METAPLASIA
Bcl-2
Vim
MESONEPHRIC HYPERPLASIA
p16
Ki67
AIS
CD10
AR
Calretinin
Vim
CEA (m)
ER
PR
p16
PAX2
PAX8
MESONEPHRIC
LESIONS
+
+
-/+
+/+
+
+ (L)
+/+/+/-/+
+
+
Obliteration of crypts
INVASIVE OR IN SITU?
AIS vs ADENOCARCINOMA
WITH EXPANSILE GROWTH
I
N
V
A
S
I
V
E
A
D
E
N
O
C
A
I
N
V
A
S
I
V
E
A
D
E
N
O
C
A
OVARIAN METASTASES
p16
ENDOMETRIUM
PgR
ADENOMA MALIGNUM
ADENOMA
MALIGNUM
(Minimal
deviation
endocervical
adenoca)
ADENOMA MALIGNUM
ADENOMA MALIGNUM
(Minimal Deviation Adenocarcinoma)
Differential Diagnosis
Deep endocervical glands and Nabothian cysts
Lobular endocervical gland hyperplasia or pyloric
gland metaplasia
Endocervical hyperplasia, NOS
Tunnel clusters
Cervical adenomyoma
Endocervicosis
DIFFERENTIAL FEATURES
Mucous discharge
Mass
Demarcation
Wall involvement
Lobulation
Cytologic atypia
LEGH
+/-/+
Present
< 50%
+
minimal
Stromal response
absent
AM
+/+
Absent
>> 50%
prominent
(at least focally)
present
CEA
Precursor lesion ?
Lobular
Endocervical Gland
Hyperplasia;
typical/atypical
Adenoma
malignum
Common features:
- Proximal location in the cervical canal
- Pyloric metaplasia (Neutral mucin-MUC6/HIK1083/PAS+)
- ER - No clear relation to high-risk HPV (p16 frequently -)
LEGH (15)
Gastric muc
+
3q gains
3/14*
1p losses
2/14*
HPV
-
AM (16)
+
5/11
4/11
-
MAC (15)
4/9
6/9
13/15 +
LOBULATION
NO STROMAL RESPONSE
NO CYTOLOGIC ATYPIA
WELL-DIFFERENTIATED
VILLOGLANDULAR ADENOCARCINOMA
Occurs at a younger age (average 35 yrs)
than cervical adenocarcinomas in general
In the series reported by Kurman and
colleagues 62% of patients had a history
of oral contraceptive use
If pure it has an excellent prognosis
VILLOGLANDULAR ADENOCARCINOMA:
Diagnosis
It is very important to evaluate the
WELL-DIFFERENTIATED
VILLOGANDULAR ADENOCARCINOMA
Differential Diagnosis
Papillary endocervicitis
Mullerian papilloma
Villous adenoma
Papillary adenofibroma
Conventional endocervical adenoca with
prominent exophytic papillary growth
Serous carcinoma
METASTATIC SEROUS CA
CLEAR CELL
CARCINOMA
Typical architectural patterns
DIFFERENTIAL FEATURES
AS
Pregnancy/OC
Incidental finding
Preserved architecture
Glandular involvement
Intranuclear inclusions
Prominent nuclei
Mitotic activity
+
+
+
+
+
Absent
CCC
+
Present
M
I
C
R
O
G
L
A
N
D
U
L
A
R
H
Tubular/Solid
Hyalinized stroma
Cytoplasm
Atypia
Mitoses/10HPFs
Invasive growth
MGH
CCC
+/+
Mucin
Absent
1
Absent
+
+
Glycogen
Present
Frequent
Present
MICROGLANDULAR HYPERPLASIA vs
MGH-LIKE CARCINOMA
Features favoring adenocarcinoma:
Postmenopausal age
Absence of typical areas of MGH
Cytologic atypia greater than expected in MGH
Increased mitotic activity (> 1 mitoses/10HPFs)
High MIB-1 index
MESONEPHRIC
CARCINOMA
Tubular growth
MESONEPHRIC CARCINOMA
Spindle growth
Papillary growth
MESONEPHRIC CARCINOMA
Differential Diagnosis
Mesonephric hyperplasia
Cervical AIS
Cervical endometrioid adenocarcinoma
Uterine tumor resembling ovarian sexcord tumor
Endometrioid carcinoma from corpus
extending to cervix
THANK YOU!
p16
MD (3)
0
Gastric (9)
1
CCC (11)
5
Serous (4)
2
Mesonephric (3) 0
p53
1
5
1
1
0
CEAm
3
8
2
3
0
HPV
0
1
0
0
0