Clear Cell Carcinoma of the Uterine Cervix: Pathology and Prognosis in Surgically Treated Stage IB–IIB Disease in Women Not Exposed in Utero to Diethylstilbestrol

Reich, Olaf; Tamussino, Karl; Lahousen, M.; Pickel, H.; Haas, Josef; Winter, Raimund

doi:10.1006/gyno.1999.5700

Cited by 77 publications

(87 citation statements)

References 26 publications

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“…There have been numerous reports describing the clinicopathological variables and prognosis of cervical CCAC. Some studies have reported that the prognosis of CCAC patients is similar to that of patients with squamous cell carcinoma [6]; however, other reports have shown that CCAC prognosis is poorer than that of other types of cervical cancers due to recurrence of cervical CCAC following chemotherapy and radiation [9]. To help achieve better prognoses in cervical CCAC, earlier diagnosis will be necessary.…”

Section: Discussionmentioning

confidence: 99%

“…CCAC was confirmed in 34 patients having a median age of 53 years. Moreover, Reich et al reported that the clinicopathological findings and prognosis of surgically treated patients with stage IB-IIB clear cell carcinomas without exposure to DES were similar to those of patients with squamous cell carcinomas and non-clear cell adenocarcinomas [6].…”

Section: Introductionmentioning

confidence: 91%

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Characteristic Cytological Features of Cervical Clear Cell Adenocarcinoma: A Report of 4 Cases

Sonoda

Nogami²,

Naka³

et al. 2013

J Cytol Histol

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We experienced 5 cases of clear cell adenocarcinoma (CCAC) of the cervix in the 10-year period from 2003 to 2012. Because a specimen from one of the cases was poorly preserved, we analyzed cytological features of the 4 remaining cases. Characteristic large, pale-staining atypical cells with prominent, round nuclei were seen in all cases. Additionally, a hobnail appearance and basement membrane-like substance were detected in 3 cases, and a mirror ball cluster-like morphology was found in 1 case. Cervical CCAC has been reported to be difficult to diagnose by cytology; however, we were able to diagnose these 4 cases by recognizing several characteristic cytological features.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Characteristic Cytological Features of Cervical Clear Cell Adenocarcinoma: A Report of 4 Cases

Sonoda

Nogami²,

Naka³

et al. 2013

J Cytol Histol

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“…(3,5) The key modality of treatment for early-stage cervical carcinoma is radical abdominal hysterectomy with pelvic lymphadenectomy, which results in permanent infertility in the patient. When CCAC of the uterine cervix occurs in adolescents and women of reproductive age, other surgical options should be considered if the patient desires to maintain her fertility after treatment.…”

Section: E T T E R T O T H E E D I T O Rmentioning

confidence: 99%

Clear cell adenocarcinoma of the cervix in a ten-year-old girl without prenatal diethylstilbestrol exposure

Asri¹,

B.K.Lim²,

Lim³

et al. 2016

smedj

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470 L e t t e r t o t h e E d i t o rDear Sir, Cervical clear cell adenocarcinoma (CCAC) accounts for 3%-10% of adenocarcinoma of the uterine cervix cases (1,2) and is often associated with diethylstilbestrol (DES) exposure in utero.(3) CCAC of the uterine cervix is uncommon in adolescents and only a few such cases have been reported. (1,4) We herein report an extremely rare case of a patient with cervical CCAC without DES exposure. A ten-year-old girl presented with a history of intermittent bloodstained discharge of one year. She was only referred to a gynaecologist after a failure to respond to hormone therapy within one year. Physical examination revealed a palpable pelvic mass that was about the size of a gravid uterus of 14 weeks, with visible tissue protruding through the introitus. Magnetic resonance imaging showed a huge mass arising from the cervix of a rudimentary uterus and pushing the pelvic organs toward the abdomen (Fig. 1). There was no evidence of organomegaly or enlarged lymph nodes. The upper and lower urinary tracts appeared normal. Biopsy confirmed the diagnosis of Stage IB2 CCAC of the uterine cervix (Fig. 2). The patient underwent radical abdominal hysterectomy and bilateral pelvic lymph node dissection, followed by six cycles of carboplatin and paclitaxel. Subsequently, pelvic examination under anaesthesia, vault cytology and computed tomography of the abdomen and pelvis were performed. Unfortunately, the patient developed recurrence in her lungs and brain. She and her family declined further treatment and the patient succumbed three months later.Previous literature showed that the first peak of CCAC occurs in women aged 17-37 years, while the second peak occurs in women aged 44-88 years. The former group comprised mostly DES-exposed women and the latter those without a history of DES exposure.(3,4) Significant features for the prognosis of CCAC of the uterine cervix are related to the stage at diagnosis, tumour size, grade of nuclear atypia, pelvic lymph node status and lymphatic invasion. (3,5) The key modality of treatment for early-stage cervical carcinoma is radical abdominal hysterectomy with pelvic lymphadenectomy, which results in permanent infertility in the patient. When CCAC of the uterine cervix occurs in adolescents and women of reproductive age, other surgical options should be considered if the patient desires to maintain her fertility after treatment. We suggest that an awareness of rare, forgotten cancers (e.g. CCAC of the uterine cervix in adolescents) and the need for prompt referral to a tertiary gynaecological oncology centre should be raised among general practitioners, gynaecologists and surgeons. Additionally, CCAC of the uterine cervix in adolescents should be considered as a possible differential diagnosis of bloodstained vaginal discharge without a history of sexual abuse or DES exposure. In the interim, specialists and physicians should remain cautious and attempt to act early, assertively and properly to diagnose and treat CCAC of the uterine cervix in adolesc...

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“…No involvement of pelvic and para-aortic lymph nodes was found. Parameters from blood chemistry studies and the levels of tumor markers were all CASE REPORT Korean 15.85 U/mL; CA 19-9, 10.7 U/mL; squamous-cell carcinoma, 0.6 ng/mL; alpha-fetoprotein, 7.9 ng/mL; beta-human chorionic gonadotropin, <1.2 mIU/mlL). There were no abnormal findings in intravenous pyelography, cystoscopy, and colonoscopy except for hyperplastic polyp in colon.…”

Section: Case Reportmentioning

confidence: 99%

“…In a Dutch series of 88 women, 76 (88.5%) had stage I-II disease [3]. The primary treatment of early disease usually involved radical surgery with pelvic±para-aortic lymphadenectomy, with outcomes comparable to other types of cervical adenocarcinoma [14,15]. Important parameters for the determination of prognosis of CCAC patients are stage, tumor size, growth pattern, nuclear atypia, and mitotic activity [1,4,5].…”

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confidence: 99%

A case of clear cell adenocarcinoma in the uterine cervix of 52-year-old virgin

Lee

Chang

Kyung

et al. 2012

Korean J Obstet Gynecol

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Clear cell adenocarcinoma (CCAC) of uterine cervix is very rare tumor and only 4%-9% of entire adenocarcinoma appears to be diagnosed as clear cell type. Risk factors and pathogenesis of this disease are not exactly revealed. The intrauterine exposure to diethylstilbestrol (DES) and associated non-steroidal estrogen during pregnancy before 18 weeks is the only known risk factor, and also hormonal changes or genetic causes are suggested as the risk factors. We report a case of CCAC in the uterine cervix of 52-year-old virgin who had never been exposed to DES, with a brief review of related literature. Copyright © 2012. Korean Society of Obstetrics and GynecologyClear cell adenocarcinoma (CCAC) of the uterine cervix is a rare disease accounting for only 4% of all adenocarcinomas of the uterine cervix. Though the etiology and pathogenesis are not clear, several studies have linked the occurrence of vaginal CCAC in young women with intrauterine exposure to the synthetic nonsteroidal estrogenic hormone, diethylstilbestrol (DES). Other factors reported to be associated with the development of CCAC are microsatellite instability, human papillomavirus infection, bcl-2 protein overexpression, and p53 gene mutation. CCAC is refractory to chemotherapy or radiation therapy, and its prognosis is poorer than that of squamous cell carcinoma of the same organ. We experienced a case of CCAC in the uterine cervix of 52-yearold virgin who had never been exposed to DES and report this case with a brief review of related literature. Case ReportA 52-year-old woman had suffered vaginal spotting for about 3 months. She visited a local gynecologist and liquid based cytology (Papanicolaou smear) was done at uterine cervix by the gynecologist. The cytology showed atypical endocervical cells that favored neoplastic changes, which then she was referred to our outpatient department for further evaluation and management. She had no history of coitus and had never been exposed to in utero exogenous steroid hormone. The vaginal examination and inspection showed caulifl ower-like mass of the cervix (Fig. 1). On rectal examination, the left parametrium was free and right parametrium was moderately thickened. High-risk human papillomavirus (hrHPV) test at uterine cervix done by hybrid capture II was negative. Histological diagnosis by punch biopsy was CCAC of the uterine cervix. Magnetic resonance imaging showed a solid mass, 1.6×2.9×2.5 cm in diameter (Fig. 2). This solid mass was protruding from the posterior lip of the cervix and extending to the upper vagina. Positron emission tomography-computed tomography was also performed, and there was evidence of tumor expansion neither to parametrium nor to endometrium. No involvement of pelvic and para-aortic lymph nodes was found. Parameters from blood chemistry studies and the levels of tumor markers were all CASE REPORT Korean J Obstet Gynecol 2012;55(3):192-196 http://dx

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Clear Cell Carcinoma of the Uterine Cervix: Pathology and Prognosis in Surgically Treated Stage IB–IIB Disease in Women Not Exposed in Utero to Diethylstilbestrol

Cited by 77 publications

References 26 publications

Characteristic Cytological Features of Cervical Clear Cell Adenocarcinoma: A Report of 4 Cases

Characteristic Cytological Features of Cervical Clear Cell Adenocarcinoma: A Report of 4 Cases

Clear cell adenocarcinoma of the cervix in a ten-year-old girl without prenatal diethylstilbestrol exposure

A case of clear cell adenocarcinoma in the uterine cervix of 52-year-old virgin

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