Cervical Adenocarcinoma

Abstract

The pattern-based classification system of endocervical adenocarcinoma correlates with nodal metastasis and clinical outcomes, but its application in biopsies is challenging. The aim of this study was the correlation of additional histologic features with patterns of invasion as well as prognosis. A total of 103 specimens from 71 cervical adenocarcinoma cases were studied. Among the 71 cases, all had resection specimens including hysterectomy, cold knife cone excision or loop electrosurgical excision procedure excision, and 32 of these had prior cervical biopsies. We applied the pattern-based classification system to all the specimens and evaluated histopathologic features microscopically. Findings in biopsies were compared with their corresponding resections and correlated with nodal status and disease stage. In 71 resection specimens, pattern A was present in 10 (14.1%), pattern B in 12 (16.9%), and pattern C in 49 (69%) cases. Of the 32 cervical biopsies, pattern of invasion could be classified in only 16 (50%) cases, including 1 (6%) with pattern A, 4 (25%) with pattern B, and 11 (69%) with pattern C. Of the 32 cervical biopsies, 30 could be evaluated for intraluminal necrotic/tumor debris and/or grade 3 nuclei, which correlated with pattern C as well as with lymph node metastasis in the subsequent staging specimens. No tumor with patterns A or B had intraluminal necrotic/tumor debris or grade 3 nuclei in either biopsy or resection specimens. Therefore, intraluminal necrotic/tumor debris and grade 3 nuclei are highly predictive histologic features for cervical adenocarcinomas with pattern C invasion and nodal metastasis.

<p>Combined Evaluation of Preoperative Serum CEA and CA125 as an Independent Prognostic Biomarker in Patients with Early-Stage Cervical Adenocarcinoma</p>

“…In previous studies, [25][26][27][28] intrinsic tumor characteristics such as FIGO stage, grade, histological type and LNM have been shown to be significant prognostic value for survival in ADC patients. Similarly, our multivariate analysis showed tumor differentiation and degree of myometrial invasion are also independent predictors of early stage ADC.…”

Dataset for the Reporting of Carcinoma of the Cervix: Recommendations From the International Collaboration on Cancer Reporting (ICCR)

“…Two sizeable studies using a 3-tier system with cut-off points for the proportion of solid architecture set at ≤ 10%, 11% to 50%, and > 50%, with tumors upgraded for marked nuclear atypia, have demonstrated the independent prognostic value of tumor grade by multivariate analysis (140,143). Other studies have reached varied conclusions, although some, including large multicentre population analyses, have similarly found tumor grade to have independent prognostic value, although the grading systems used and histologic tumor types examined were not always reported (34,126,127,(144)(145)(146)(147).…”

Tumoral Morphologic Features From Cervical Biopsies That Are Predictive of a Negligible Risk for Nodal Metastasis and Tumor Recurrence in Usual-type Cervical Adenocarcinomas

“…(a) TNG: Nuclear grade was categorized as 1 (low; TNG1), 2 (intermediate; TNG2), or 3 (high; TNG3) as defined recently. 13…”

“…9,10 Patients with NM discovered after radical hysterectomy, and primary staging surgery are typically given adjuvant treatment with chemotherapy and radiation, which may potentially be associated with substantial side effects. [11][12][13][14][15][16] Currently, the prediction of prognosis and the selection of patients for postoperative adjuvant treatment after radical hysterectomy is guided by a combination of surgical-pathologic findings as well as other findings from clinical staging. 17,18 However, because of substantial differences in the biological behavior of individual EACs classified as being within the same stage, the metastatic or recurrent potential of localized tumors is difficult to predict.…”

“…Recently, a pair of studies from our group reported that high tumor nuclear grade (TNG) and the presence of necrotic tumor debris (NTD) in EACs that were diagnosed in cervical biopsies are highly predictive of NM. 13,14 However, the reported sample sizes were relatively small, the data were from a single institution, and the negative predictive values of TNG and NTD were not robustly addressed. In the present multi-institutional follow-up study, we aimed to investigate whether these microscopically identifiable features from cervical biopsy specimens can reliably predict nodal metastases and patient outcomes in a large cohort of patients with HPVA EAC.…”