Cytopathological observations in a 27‐year‐old female patient with endometrioid adenocarcinoma arising in the lower uterine segment of the uterus

Abstract

The determination of the malignancy of an endometrioid adenocarcinoma arising in the lower uterine segment (LUS) is diffıcult because of the high degree of differentiation of adenocarcinoma. The cytopathological and immunohistochemical features of endometrioid adenocarcinoma arising in the LUSThe uterine lining is anatomically divided into two regions: the mucosa of the lower uterine segment (LUS) and the corpus mucosa proper, the former being thinner than the latter. 1,2 In the LUS mucosa, glands often contain ciliated cells and show a gradual transition to endocervical glands, and the stroma is more fibrous than the cellular stroma of the corpus mucosa proper. Both glands and stroma of this portion tend to respond weakly to hormonal stimulation. 3 According to Hachisuga et al., 3 in a comparison with common endometrial tumors of the corpus, tumors of the LUS tended to be high-grade adenosquamous carcinomas, and myometrial invasion was more extensive. The LUS bridges the endocervix and the uterine corpus with a gradual transition between the two sites, resulting in a hybrid appearance in the glands and stroma of this region. 4 The short-term follow-up revealed that LUS tumors, which were known to be p53-positive and estrogen receptor (ER)-and progesterone (PR)-negative, endometrioid adenocarcinoma was categorized in estrogen-unrelated tumors, carried an unfavorable prognosis. [5][6][7] In the case of minimal-deviation adenocarcinoma (MDA) of the cervix, the cells lining the glands lack cytological features of malignancy. 8 In this connection, we present the clinicopathological and immunohistochemical features of a young patient with endometrioid adenocarcinoma accompanying squamous metaplasia arising in the LUS. The cytological and immunohistochemical characteristics are discussed in light of their malignancy and/or borderline findings. Case ReportA 27-yr-old female presented at our hospital with the complaint of abdominal pain, which was diagnosed as hemorrhagic infarct due to ovarian torsion of the right ovary.

Endometrioid adenocarcinoma of the uterus with a minimal deviation invasive pattern

“…It is characterized by a proliferation of infiltrative mildly atypical endometrial glands with no or minimal stromal reaction. Seven cases with cervical involvement and three cases with isthmus involvement have been reported 1–4 . It has also been described in the body of the uterus 5–7 .…”

“…Seven cases with cervical involvement and three cases with isthmus involvement have been reported. [1][2][3][4] It has also been described in the body of the uterus. [5][6][7] Some authors have included minimal deviation adenocarcinoma of endometrioid type in a category they termed 'diffusely infiltrating endometrial adenocarcinoma'.…”

Cytomorphologic features of metastatic endometrioid carcinoma by fine needle aspiration

“…Thus, prior cytologic characterization of EMCA in the literature is limited. 13,14 Studies describing endometrial adenocarcinoma on cervical pap smears (generally without mention of the histologic subtype) have reported glandular structures with nuclear enlargement, conspicuous nucleoli, scant vacuolated cytoplasm, and occasional squamous differentiation. 15,16 Interestingly, endometrial carcinomas with serous or clear cell histologies have a higher likelihood of having abnormal Pap smears than EMCAs.…”