Adenoma malignum of the cervix.A cancer of deceptively innocent histological pattern

McKelvey, J.L.; Goodlin, R. R.

doi:10.1002/1097-0142(196305)16:5<549::aid-cncr2820160502>3.0.co;2-m

Cited by 74 publications

(22 citation statements)

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“…24,33 However, minimal deviation adenocarcinoma should be differentiated from lobular endocervical glandular hyperplasia since an extremely poor prognosis has been reported in patients with minimal deviation adenocarcinoma. [41][42][43] In this rare highly differentiated mucinous adenocarcinoma, occasional glands display moderate nuclear atypia and elicit a desmoplastic stromal reaction, while most of the glands are impossible to distinguish from non-neoplastic endocervical glands including lobular endocervical glandular hyperplasia. According to WHO classification, haphazard arrangements of glands that extend deeply into the cervical stroma and the presence of occasional mitoses are reliable histological criteria for differentiating minimal deviation adenocarcinoma from the various benign endocervical lesions.…”

Section: Discussionmentioning

confidence: 99%

Endocervical adenocarcinomas associated with lobular endocervical glandular hyperplasia: a report of four cases with histochemical and immunohistochemical analyses

et al. 2005

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We report on four cases of endocervical adenocarcinoma associated with lobular endocervical glandular hyperplasia using histochemical and immunohistochemical analyses. The patients ranged in age from 59 to 67 years (mean 62 years). Chief complaints were watery vaginal discharge in two cases, genital bleeding in one and no subjective symptoms in one. Cytological examinations of the cervical smears revealed adenocarcinoma cells and benign-looking glandular cells with intracytoplasmic golden-yellow mucin in all cases. Radical hysterectomy was performed in three patients, and simple total hysterectomy was performed in one. From surgical specimens, three tumors were diagnosed as mucinous adenocarcinoma and one was adenocarcinoma in situ. All adenocarcinomas were located proximally on the cervix, and did not involve the transformation zone. Adjacent to carcinoma tissues in the cervix, lobular endocervical glandular hyperplasia was detected. The cells of lobular endocervical glandular hyperplasia were dominantly positive with neutral mucin, and immunohistochemistry revealed that these cells had prominent pyloric gland mucin (HIK1083). Focal immunopositivity for pyloric mucin was also observed in three adenocarcinomas. Either CEA or p53 were immunopositive in all adenocarcinomas and negative in the tissues of lobular endocervical glandular hyperplasia. Histopathological features of the present cases suggest that some endocervical adenocarcinomas may originate from lobular endocervical glandular hyperplasia. Keywords: endocervical adenocarcinoma; lobular endocervical glandular hyperplasia; gastric mucin; HIK1082; immunohistochemistry; histochemistry Endocervical adenocarcinomas account for 10-15% of all cervical cancers and have been increasing in relative and absolute numbers.1-4 Therefore, understanding the precursor lesions of endocervical adenocarcinoma has become more important for gynecologists and pathologists. Endocervical glandular dysplasia and atypical tubal metaplasia are recognized premalignant lesions, and a considerable number of studies on these lesions have been conducted so far. [5][6][7][8][9][10][11][12][13] Consequently, the question arises whether other precursors exist. Microglandular hyperplasia, 14-17 mesonephric hyperplasia, 18,19 tunnel clusters, 20-22 diffuse laminar endocervical glandular hyperplasia 23 and lobular endocervical glandular hyperplasia are currently considered benign hyperplastic glandular lesions in the uterine cervix, 24 but little is really known about their relationship with endocervical carcinomas. 25,26 Recently, several studies have focused on gastric mucin (or pyloric gland mucin) in glandular lesions of the cervix and its connection with endocervical glands' carcinogenesis. Gastric phenotype has been described in endocervical gastric metaplasia, lobular endocervical

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Section: Discussionmentioning

confidence: 99%

Endocervical adenocarcinomas associated with lobular endocervical glandular hyperplasia: a report of four cases with histochemical and immunohistochemical analyses

et al. 2005

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“…In particular, minimal deviation adenocarcinoma (MDA) or adenoma malignum, a variant of CxAd, is histologically very similar to normal endocervical glands or LEGH and is frequently difficult to diagnose preoperatively [3,9,11,12,17]. Using conventional alcian blue (pH 2.5)/periodic acid-Schiff (AB-PAS) staining, we previously found that mucin secreted from normal endocervical glands contains both acid and neutral mucin, but mucin secreted by the cells of MDA is composed primarily of neutral mucin [6].…”

Section: Introductionmentioning

confidence: 99%

Difference in cytoplasmic localization pattern of neutral mucin among lobular endocervical glandular hyperplasia, adenoma malignum, and common adenocarcinoma of the uterine cervix

et al. 2003

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To investigate whether the cytoplasmic localization pattern of neutral mucin differs between lobular endocervical glandular hyperplasia (LEGH) and cervical adenocarcinoma (CxAd), including minimal-deviation adenocarcinoma (MDA), or adenoma malignum, alcian blue (pH 2.5)/periodic acid-Schiff (AB-PAS) staining was performed to formalin-fixed paraffin-embedded tissue sections of 13 lesions of LEGH and 53 tumors of CxAd, including 6 tumors of MDA. The cytoplasmic localization of neutral mucin was classified as a "whole cytoplasmic pattern," in which neutral mucin filled the cytoplasm entirely, or as an "apical pattern," in which neutral mucin was localized in the subsurface area only. Cytoplasmic neutral mucin patterns were detected in all 13 cases of LEGH and in 19 cases (36%) of CxAd, including five cases of MDA. The localization of neutral mucin was always the whole cytoplasmic pattern in 13 cases of LEGH, but was the apical pattern in these 19 cases of CxAd. The other 34 cases of CxAd, including 1 case of MDA, corresponded to the acid mucin pattern stained purple or blue or no staining pattern by AB-PAS. Among the 53 cases of CxAd, the apical neutral mucin pattern was an indicator of poorer patient prognosis by univariate and multivariate analyses. The examination of cytoplasmic localization of neutral mucin might be applicable, not only to differential diagnosis between LEGH and CxAd, including MDA, but also to estimate clinical aggressiveness of CxAd.

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“…Subsequently Mckelvey and Goodlin in a case series described various presentations of Adenoma Malignum, red, granular, nodular cervix with the lesion invading the vagina; friable, cauliflower-shaped mass; cervical erosion; recurrence in cervical conisation stump or vault recurrence subsequent to hysterectomy 10 .…”

Section: Discussionmentioning

confidence: 99%

Minimal deviation adenocarcinoma ("adenoma malignum") of the cervix: A diagnostic dilemma

Banerjee¹

2013

IOSR-JDMS

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Adenoma malignum of the cervix.A cancer of deceptively innocent histological pattern

Cited by 74 publications

References 1 publication

Endocervical adenocarcinomas associated with lobular endocervical glandular hyperplasia: a report of four cases with histochemical and immunohistochemical analyses

Endocervical adenocarcinomas associated with lobular endocervical glandular hyperplasia: a report of four cases with histochemical and immunohistochemical analyses

Difference in cytoplasmic localization pattern of neutral mucin among lobular endocervical glandular hyperplasia, adenoma malignum, and common adenocarcinoma of the uterine cervix

Minimal deviation adenocarcinoma ("adenoma malignum") of the cervix: A diagnostic dilemma

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