Glassy cell carcinoma of cervix: an analysis for 20 cases and literatures review

Abstract

Background Glassy cell carcinoma (GCC) of the cervix is defined as a rare subtype of adeno-squamous cell carcinoma (ASC) with poor prognosis. We presented our clinical data of patients with cervical GCC and reviewed the outcomes in recent years. Methods From 2011.1 to 2019.7, 20 cases of cervical GCC diagnosed and treated in our institution were reviewed for clinicopathologic features, treatment strategies, and outcomes. Results (I) Twenty cases confirmed as cervical GCC were selected and represented 1.8% of all invasive cervical cancer diagnoses. The median age of all cervical GCC patients was 46 years (range from 33 to 69 years). The main clinical symptoms were abnormal vaginal bleeding and postcoital bleeding. The incidence of stage I, stage II, stage III was 75%, 20% and 5%. (II) Human papillomavirus (HPV) prevalence in cervical GCC was 44.4% (4/9). Of the HPV-positive tumors, HPV genotyping was variable. Tumors of 3 cases were found infected by HPV-18. Another tumor was infected by HPV-16 and HPV-31. Multiple infections were found in 1 case. (III) The disease-free survival (DFS) of early stage cervical GCC cases was 93%, and DFS of advanced stage cervical GCC cases was 67%. DFS of all cases was 85%. The median follow-up interval for surviving patients was 28 months. Three patients recurred, leading to an overall recurrence rate of 15% (3/20). One of 3 recurred cases was from multimodal treatment group who had one high risk factor (pelvic lymph node metastasis) and three intermediate risk factors lympho-vascular space involvement (LVSI), deep stromal invasion, and large tumor size (3.5 cm). Other 2 cases recurred were from radio-chemotherapy group. Conclusions Cervical GCC is associated with high-risk type HPV infection, especially HPV 18. The prognosis of GCC was not poor as depicted in previous studies. Early-stage GCC patients should receive multimodal treatment which reduced recurrence rate and improved survival rate. With the limitation of small sample size, we speculated surgery might play a key role in curing GCC. Patients whose pathology features includes at least two intermediate high risk recurrence or one high risk factor should accept adjuvant treatment after complete surgical management.

Conservative treatment of glassy cell cervical cancer: A case report

“…8 and 9 ) ( 12 ). GCC accounts for almost 5% of all cervical cancers, 40% of which are diagnosed in reproductive-aged women ( 4 ), with a median age ranging between 28 years and 41 years, as described by Boustani et al ( 2 ), Hopkins and Morley ( 11 ) and Guitarte et al ( 13 ), respectively ( 2 , 11 , 13 ). Incidence at a younger age, with most cases presenting at early stages (stage I–II) associated with the tendency to delay motherhood nowadays, shed light on conservative and fertility-preserving strategies ( 2 ).…”

“…They are commonly associated with a higher risk of recurrence and death. GCC of the cervix is a rare but aggressive subtype of cervical cancer, considered a variation of Adenosquamous Carcinoma (ASC); It accounts for less than 1-2% of all cervical cancers and is usually diagnosed at a mean age 10 years younger than other histologies (4). Possible associations were suggested between GCC and high-risk human papillomavirus infection (HPV 16,18,32) and recent or current pregnancies (5).…”

A Unique Glassy Cell Carcinoma (GCC) of the Cervix Diagnosed during Pregnancy—A Case Report

“…The first symptom of GCC, similar to other types of cervical cancer, is abnormal vaginal bleeding, which also occurred in our pregnant patient [ 3 , 4 ]. In the study of Wang et al, 100% of patients with Cervical GCC went to the doctor due to vaginal bleeding [ 15 ]. According to the International Federation of Gynecologists and Obstetricians, the stage of IB1 is found in 93.3% in non-pregnant patients [ 3 , 5 , 16 ].…”

“…Wang et al, in an analysis of 20 cases of women with cervical GCC, described a diagnosis of stage I cancer in 75% of patients. In the second degree in 20% of patients and in the III degree in 5% of patients [ 15 ]. In the case presented in this paper, the level of advancement was defined as IB3.…”

“…Local recurrence usually occurs at the apex of the vagina, parametrium and para-aortic lymph nodes. Distant metastases beyond the pelvis minor are also observed, including to the lungs, liver, spleen and bones [ 5 , 15 ]. A good response to adjuvant chemotherapy after surgical treatment is also confirmed by Takahashi’s analyses.…”