Cytologic and cytochemical features of adenoma malignum of the uterine cervix

Ishii, Keiko; Katsuyama, Tsutomu; Ota, Hiroyoshi; Watanabe, Chiho; Matsuyama, Mutsushi; Tsuchiya, Satoshi; Shiozawa, Tanri; Toki, Toshihiko

doi:10.1002/(sici)1097-0142(19991025)87:5<245::aid-cncr2>3.0.co;2-0

Cited by 67 publications

(57 citation statements)

References 17 publications

(10 reference statements)

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“…However, it will be difficult to differentiate lobular endocervical glandular hyperplasia from minimal deviation adenocarcinoma solely based on mucin colors since golden-yellow cytoplasmic mucin also has been suggested as representing the cytological features of minimal deviation adenocarcinoma. 57 We found intranuclear cytoplasmic inclusions in the lobular endocervical glandular hyperplasia cells in all four cases, but did not detect them in cancer cells. Since we have found no reports of these inclusions in other glandular lesions of the uterine cervix, this nuclear finding might be one of the cytological characteristics of lobular endocervical glandular hyperplasia.…”

Section: Endocervical Adenocarcinoma With Hyperplasiamentioning

confidence: 67%

“…Second, confusion on the diagnosis of benign hyperplastic lesions and minimal deviation adenocarcinoma might elicit an increased number of lobular endocervical glandular hyperplasia diagnoses. Since Ishii and co-workers 30,32,57 described the cytological and histological features of minimal deviation adenocarcinoma, we have actively interpreted golden-yellow mucin in Pap smears and gastric mucin in histological specimens (findings are now thought to be nonspecific for minimal deviation adenocarcinoma) as indicators of minimal deviation adenocarcinoma. Third, for the purpose of finding the early stage of minimal deviation adenocarcinoma, we tested a vaginal discharge screening test using enzyme-linked immunosorbent assay for HIK1083 in gynecology outpatients.…”

Section: Endocervical Adenocarcinoma With Hyperplasiamentioning

confidence: 99%

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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: Endocervical Adenocarcinoma With Hyperplasiamentioning

confidence: 67%

Section: Endocervical Adenocarcinoma With Hyperplasiamentioning

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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“…A cytological diagnosis was made according to the Bethesda system. Gastric‐type mucin in the cervical mucus was examined using a latex agglutination assay (HIK1083 kit)26 or by the detection of ‘yellow’ or ‘orange’ mucin in the cervical Pap smear 4. A clinical diagnosis and subsequent treatment were summarized as follows: the patient's condition was regarded as suspicious of MDA or adenocarcinoma (S/O MDA‐Ca) when pelvic MRI revealed a predominant solid component or invasive lesion and/or atypical glandular cells (AGC) in the Pap smear.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of a management protocol for patients with cervical multicystic lesions: A retrospective analysis of 94 cases and the significance of GNAS mutation

Ando

Miyamoto

Kashima

et al. 2016

J of Obstet and Gynaecol

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AimThe proper preoperative diagnosis and management of cervical proliferative disorders presenting with multiple cysts, including minimal deviation adenocarcinoma (MDA), lobular endocervical glandular hyperplasia (LEGH), and nabothian cyst (NC), have not been fully established. We previously proposed a management protocol comprising a diagnostic approach using cytology, magnetic resonance imaging, and gastric‐type mucin and subsequent treatment. We herein evaluate the usefulness of this protocol and implications of GNAS mutations in LEGH.MethodsThe clinical courses of 94 patients with cervical multicystic lesions who visited our hospital between June 1995 and September 2014 were retrospectively analyzed. GNAS mutations were investigated in 10 LEGH, five LEGH with atypia, and two MDA cases.ResultsOf the 94 patients, the conditions of 10, 59, and 25 were clinically diagnosed as suspicious of MDA or carcinoma (S/O MDA‐Ca), suspicious of LEGH (S/O LEGH), and NC, respectively. Ten patients each with S/O MDA‐Ca and S/O LEGH underwent hysterectomy, and the correct ratio for diagnosis was 90% (18/20). Of the 42 S/O LEGH cases followed‐up for more than 12 months, three showed an increase in tumor size. After hysterectomy, two were LEGH with atypia while one was NC. The GNAS mutation was detected in two cases of LEGH with atypia, one of which showed an increase in tumor size during follow‐up.ConclusionThe management protocol we propose herein will be useful. An increase in tumor size is important to detect potentially malignant LEGH. GNAS mutations may be involved in the tumorigenesis of potentially malignant LEGH.

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“…2,3 This antibody has since then been regarded as a promising diagnostic tool for MDAs. 4,5 However, its usefulness has been in dispute and Mikami et al 6,7 have demonstrated HIK1083 reactivity in pyloric gland metaplasia (PGM) of the cervix, which was described as lobular endocervical glandular hyperplasia (LEGH) by Nucci et al 8,9 These facts have provoked controversy concerning a possible link between LEGH/ PGM and MDA, and whether gastric phenotype is specific for these two conditions. In the current study, we have examined cervical adenocarcinomas including MDAs, adenocarcinoma in situ (AIS), and LEGH/PGM as well as a variety of benign glandular lesions to determine the incidence of gastric phenotypes and to shed light on the issue of histogenesis of MDA, employing antibodies to apomucins encoded by the MUC gene family, CD10 and chromogranin A (CGA), and HIK1083 and anti-p16 INK4 , the last for showing any relationship to high-risk HPV.…”

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confidence: 99%

Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions: a possible link between lobular endocervical glandular hyperplasia/pyloric gland metaplasia and ‘adenoma malignum‘

et al. 2004

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Gastrointestinal phenotype in cervical adenocarcinomas was examined by immunohistochemistry and correlated with morphologic features. Antibody panels included anti-MUC2, MUC6, CD10, chromogranin A (CGA) and HIK1083. In addition, expression of p16 INK4 , a cyclin-dependent kinase inhibitor which is expressed in a variety of high-risk HPV-related conditions, was studied. A total of 94 invasive adenocarcinomas including 20 minimal deviation adenocarcinomas (MDAs) and 72 adenocarcinomas in situ (AIS) were examined. MDAs were most frequently positive for HIK1083 and/or MUC6, two representative gastric markers, with a rate of 95%, followed by intestinal-type adenocarcinomas (IAs) with a rate of 85% whereas only 27% of 56 usual endocervical-type adenocarcinomas (UEAs) were positive. MUC2, a goblet cell marker, was positive in 85% and 25% of IAs and MDAs, respectively, while in only 14% of UEAs. CD10 was positive in 15% of IAs, indicating incomplete intestinal differentiation without a brush border in most of the cases. CGA-positive cells were frequently seen in MDAs and IAs with rates of 60% and 62%, respectively. Nuclear and cytoplasmic p16 INK4 positivity was identified in 93% of UEAs, whereas 30% of MDAs were positive for p16 INK4 . Results in AISs were comparable to their invasive counterparts, but morphologically usual-type AISs identified in eight cases of MDA were frequently positive for HIK1083 (75%) and MUC6 (63%), and p16 INK4 . Of note was the existence of lobular endocervical glandular hyperplasia (LEGH) with atypical features including cytologic abnormalities, and/or papillary projection, which were identified in this study in pure form (n ¼ 3) or in association with MDAs (n ¼ 6), but not in cases of other types of adenocarcinomas. These observations indicate that gastrointestinal phenotype is frequently expressed in MDAs and IAs, and there seems to be a possible link between MDA, and LEGH and morphologically usual-type AIS with gastric immunophenotype in histogenesis. Frequent absence of p16 INK4 expression in MDAs suggests a possibility that high-risk HPV does not play a crucial role in development of MDAs, in contrast to the majority of endocervical adenocarcinomas. p16 INK4 immunohisto-

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Cytologic and cytochemical features of adenoma malignum of the uterine cervix

Cited by 67 publications

References 17 publications

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

Usefulness of a management protocol for patients with cervical multicystic lesions: A retrospective analysis of 94 cases and the significance of GNAS mutation

Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions: a possible link between lobular endocervical glandular hyperplasia/pyloric gland metaplasia and ‘adenoma malignum‘

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