Clinical Diagnosis and Treatment Analysis of 16 Cases of Gastric-Type Endocervical Adenocarcinoma

Abstract

Objective: Cervical cancer classification based on human papillomavirus (HPV) infection status is necessary, as the popularity of HPV vaccination is increasing. Hence, this study aimed to explore the clinicopathological features, diagnosis, treatment, and prognosis of gastric-type endocervical adenocarcinoma (GAS) in west China. Methods: We performed a retrospective analysis and follow-up of patients with GAS who were hospitalized in West China Second University Hospital, a tertiary care center in west China, between September 2019 and April 2021. Results: A total of 16 cases were pathologically diagnosed as GAS at the hospital, most of which had no specific clinical manifestations. Among the 16 cases, 3 cases were confirmed preoperatively. The occurrence of full-layer cervix stroma infiltration, lymphatic vessel infiltration, and lymph node metastasis were 87.5%, 100%, and 50%, respectively. Among all cases, 8 cases were classified as stage III according to the International Federation of Gynecology and Obstetrics 2018 Clinical Staging Standard for cervical cancer. A total of 15 patients underwent a transabdominal or laparoscopic extensive hysterectomy, and the remaining 1 patient was pathologically diagnosed with GAS after a total hysterectomy and afterward underwent bilateral oophorectomy and pelvic lymph node dissection as supplementary surgeries. The follow-up data presented the survival of the 16 patients receiving concurrent chemoradiotherapy after surgery. However, GAS recurred in 3 non-medically-controlled patients among the 16 patients in 3 to 6 months after the treatment. Conclusions: GAS is a rare but highly malignant cancer that usually results in a poor prognosis. A few reports of GAS diagnosis and treatment, especially from developing countries, are available. Hitherto clinical routine screening methods might be insufficient to fulfill the requirements of GAS diagnosis owing to the difficulties in preoperative diagnosis and the probability of misdiagnosis. To reduce the rate of misdiagnosis, repeated deep multisite biopsies, cervical curettage, cervical conization, and hysteroscopy might be helpful in suspicious GAS cases.