Micropapillary Cervical Adenocarcinoma

Abstract

Micropapillary adenocarcinoma has been reported as an aggressive variant of adenocarcinoma in several organs, where it is associated with poor clinical outcome. This study reports the clinicopathologic features and outcomes of cervical adenocarcinomas with a micropapillary component (micropapillary cervical adenocarcinomas); this represents the largest reported study of these neoplasms. The study comprised 44 cervical adenocarcinomas of usual (human papillomavirus–related)-type (84%), mucinous, not otherwise specified (4.5%), gastric-type (4.5%), endometrioid (4.5%), and adenosquamous carcinoma (2%). The micropapillary component comprised >50% of the neoplasm in 34 cases (77%) (group 1), and 10% to 50% in 10 cases (23%) (group 2). Lymph node metastasis was present in 41 of 44 (93%) cases and typically the nodal tumor retained a prominent micropapillary morphology. Follow-up ranged from 7 to 123 months (mean, 65.9 mo). Seventeen of 44 (38.6%) patients had no evidence of disease on follow-up, 6/44 (13.6%) were alive with disease, and 21/44 (47.7%) died of disease. There were no survival differences between group 1 and group 2. On univariate analysis, lymph node metastasis (P=0.0015), lymphovascular space invasion (P=0.002), parametrial involvement (P=0.03), and depth of stromal invasion (P=0.045) were related to tumor recurrence. On multivariate analysis, lymph node metastasis (P=0.001), and extent of lymphovascular space invasion (P=0.027) were significant independent predictors of tumor recurrence. Our study shows that a micropapillary component in cervical adenocarcinoma may be associated with aggressive behavior and that a micropapillary architecture may occur within a variety of types of cervical adenocarcinoma.

Invasive Squamous Cell Carcinoma of the Cervix: A Review of Morphological Appearances Encountered in Human Papillomavirus-associated and Papillomavirus-independent Tumors and Precursor Lesions

“…Other rare patterns have been reported in the literature. HPVA SCCs can have micropapillary architecture, which was recently described by Alvarado-Cabrero et al 55 in HPVA and HPVI adenocarcinomas, characterized by an association with lymph node metastases and aggressive behavior. Mammary lobular carcinoma-like patterns can usually be distinguished from metastatic lobular carcinoma by the clinical and morphologic contexts, but presumably, this pattern could present problems in small samples.…”

Villoglandular Pattern in HPV-associated Endocervical Adenocarcinoma is Associated With Excellent Prognosis: A Reappraisal of 31 Cases Using IECC and Silva Pattern Classification

“…In addition, since the original description of VGA, there has been a major paradigm shift in the classification of ECAs based on the International Endocervical Adenocarcinoma Criteria and Classification (IECC) study (11). Rather than using pure histologic appearance, ECAs are now classified by the World Health Organization (WHO) according to clinically meaningful groups based on their etiological association with human papillomavirus (HPV) infection into HPV-associated (HPVA) and HPVindependent (11,12). The most common type of ECA is HPVA usual type and 2 specific architectural patterns are recognized as part of the usual type spectrum: villoglandular and micropapillary.…”

“…This may be due, in part, to the lack of adherence to strict diagnostic criteria as originally described by Young and Scully (1). VGAs are characterized by 2 main features: (1) predominant exophytic papillary architecture and (2) tumor cells showing no more than mild to moderate nuclear atypia (1,11,12). While there can be some desmoplastic stromal infiltration at the base, it should not be extensive, and there can be no component that is architecturally poorly differentiated or has high nuclear grade (11,12).…”

“…VGAs are characterized by 2 main features: (1) predominant exophytic papillary architecture and (2) tumor cells showing no more than mild to moderate nuclear atypia (1,11,12). While there can be some desmoplastic stromal infiltration at the base, it should not be extensive, and there can be no component that is architecturally poorly differentiated or has high nuclear grade (11,12). Importantly, conservative therapy is only recommended in the setting of no more than superficial destructive invasion, no lymphovascular invasion (LVI) and complete excision with negative margins (cone or hysterectomy).…”

“…The most common type of ECA is HPVA usual type and 2 specific architectural patterns are recognized as part of the usual type spectrum: villoglandular and micropapillary. While the micropapillary pattern has been recently described as being highly aggressive, the prognosis of villoglandular pattern has been a source of debate since its original description 13. This may be due, in part, to the lack of adherence to strict diagnostic criteria as originally described by Young and Scully 1.…”