Mixed Adenosquamous Carcinoma of the Endometrium

Ng, A.; Reagan, James W.; Storaasli, John P.; Wentz, W. Budd

doi:10.1093/ajcp/59.6.765

Cited by 90 publications

(12 citation statements)

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“…An immunoperoxidase method using a polyclonal antipapillomavirus antibody was used followed by visualisation with an avidin-biotin complex detection system (Dako). DNA in situ hybridisation for HPV was applied to sections of adenoacanthoma in 11 cases using biotinylated probes specific for HPV types 6/1 1 2). These cellular changes occurred both superficially and deeply within the tumours.…”

Section: Methodsmentioning

confidence: 99%

Adenoacanthoma of the endometrium: morphological changes induced by human papillomavirus.

et al. 1990

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The observation of koilocyte-like features in the squamous epithelium of some endometrial adenoacanthomas prompted an investigation into a possible viral aetiology. These changes closely resemble those that occur in the ectocervical mucosa which are accepted as morphological evidence of human papillomavirus (HPV) infection. Sections of 87 hysterectomy specimens removed for endometrial carcinoma over 12 years, together with preoperative curettings, were reviewed for the presence of acanthomatous change and for appearances suggestive of HPV infection. The ages of the women ranged from 36 to 84 years, average age 62-6. Light microscopical examination showed koilocytosis, papillary formations, and intranuclear eosinophilic inclusions of both squamous and glandular epithelium in some tumours. Immunocytochemistry and DNA in situ hybridisation indicated the presence of HPV antigen in squamous and glandular cells, and perinuclear virus particles characteristic of HPV were seen on electron microscopical examination in those cells with nuclear inclusions.HPV probably infects endometrial adenocarcinomas directly from the cervix but it is unlikely that it has an aetiological role. It is possible, however, that in addition to being a "passenger," the virus may stimulate squamous metaplasia in some adenocarcinomas of the endometrium and may also exert some influence on their behaviour. With this in mind, we reviewed the sections of all uterine carcinomas received in this laboratory over 12 years and attempted to establish the presence of HPV in those with a squamous component. MethodsSections of hysterectomy specimens removed for endometrial carcinoma between 1977 and 1988 inclusive were re-examined for the presence of a squamous component. The occurrence of squamous epithelium of benign histological appearance intimately mingling with the tumour, however small in amount, was accepted as evidence of acanthomatous change. Note was also taken of epithelial changes which might be ascribed to HPV infection, such as cytoplasmic vacuolation and koilocyte-like change. Sections of cervix, when present, were also reviewed for similar epithelial appearances and for the presence of squamous metaplasia. Preoperative endometrial curettings were also re-examined.In two hysterectomy specimens showing adenoacanthoma of the endometrium multiple circumferential blocks of the total cervix were taken, which extended from the ectocervix to the lower uterine cavity, to ascertain whether there was a direct connection between cervical metaplastic epithelium and the endometrium. Immunohistochemistry for HPV was performed on sections of 23 adenoacanthomas and the accompanying cervix, and six endometrial curettings were also included. An immunoperoxidase method using a polyclonal antipapillomavirus antibody was used followed by visualisation with an avidin-biotin complex detection system (Dako). DNA in situ hybridisation for HPV was applied to sections of adenoacanthoma in 11 cases using biotinylated probes specific for HPV types 6/1 1, 16/18, ...

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Section: Methodsmentioning

confidence: 99%

Adenoacanthoma of the endometrium: morphological changes induced by human papillomavirus.

et al. 1990

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“…These tumors were originally thought to be rare, characterized by benign squamous metaplasia within an adenocarcinoma and associated with a favorable prognosis (51). They subsequently became recognized as common and were eventually separated into adenocarcinomas with benign-and malignant-looking squamous components, the former called adenocarcinoma with squamous metaplasia or adenoacanthoma and the latter called mixed adenosquamous carcinoma (52,53). Because the natural history depends more on the glandular than the squamous component, the most recent stage in the consideration of these tumors is that they may all be combined as adenocarcinomas with squamous differentiation, with the decision of whether to subdivide them left to the individual pathologist (54).…”

Section: Subtypes Of Endometrioid Adenocarcinomamentioning

confidence: 99%

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Silverberg

2000

Modern Pathology

138

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The differential diagnosis of endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma is complicated not only by the resemblance of these lesions to each other, but also by their tendency to be overdiagnosed (particularly hyperplasia) on the background of polyps, endometritis, artifacts, and even normally cycling endometrium. Atypical hyperplasia may also be overdiagnosed when epithelial metaplastic changes occur in simple or complex hyperplasia without atypia. Lowgrade adenocarcinomas are best recognized by architectural evidence of stromal invasion, usually in the form of stromal disappearance, desmoplasia, necrosis, or combinations of these findings between adjacent glands. Endometrioid adenocarcinomas are usually Type 1 cancers associated with manifestations of endogenous or exogenous hyperestrogenic stimulation and a favorable prognosis. Subtypes include adenocarcinomas with squamous differentiation and secretory, ciliated cell and villoglandular variants. Rules and pitfalls in the grading of endometrioid adenocarcinomas and the estimation and reporting of myometrial invasion are presented.KEY WORDS: Differential diagnosis, Endometrial carcinoma, Endometrial hyperplasia, Grading, Myoinvasion. Mod Pathol 2000;13(3):309 -327The purpose of this article is to review the relationships between hyperplasia and adenocarcinoma of the endometrium, with an emphasis on the differential diagnostic problems both between these two lesions and between them and other entities that enter into the differential diagnostic picture. However, differential diagnosis is not the only relationship between endometrial hyperplasia and carcinoma. During the course of this review, we briefly consider the questions of the progression of endometrial hyperplasia (and specifically its atypical variant) to carcinoma, as well as the prognostic effect of the presence of endometrial hyperplasia in cases of endometrial carcinoma, and the biologic significance of carcinoma that arises in the presence or absence of hyperplasia. The last of these topics, however, is considered in much greater detail in the article by Sherman (1) in this issue.There are four possible approaches to making the differential diagnosis between atypical endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma of the endometrium. These approaches may be summarized briefly as follows:(1) adenocarcinoma in situ, (2) endometrial intraepithelial neoplasia (EIN), (3) nonhistologic techniques, and (4) so-called "routine" light microscopy.The oldest of these approaches is the first, in which it is assumed that there must be an entity, conveniently named adenocarcinoma in situ, that is intermediate between the most severe atypical hyperplasia and the earliest focal change recognizable as invasive adenocarcinoma. Probably the most effective rebuttal of this concept for diagnostic purposes was made by Professor Harold Fox, who stated, "A true adenocarcinoma in situ of the endometrium is one in which the glands have undergone neoplastic change bu...

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“…Similarly, the series of Ng et al had only three of 68 patients with MC having small cell-type squamous elements. 27 There were no basic differences in stage distribution for any of the three entities nor were there any solid differences in five-year survival stage by stage for AC, AA, or MC (Table 7). In fact, it can be stated that endometrial cancer, regardless of type, at least in our institution, is seen at very early stages; over 80% of the patients are Stage I and over 90% Stages I and I1 (Table 7).…”

Section: Discussionmentioning

confidence: 88%

Adenosquamous carcinoma of the endometrium.An entity with an inherent poor prognosis?

Salazar

Depapp

Bonfiglio

et al. 1977

Cancer

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Mixed adenosquamous carcinoma of the endometrium have been reported in recent years to have a steady increase in incidence, extreme aggressiveness, poor responses to radiation therapy, and a low five-year survival (less than 20%). In the present report, 87 mixed carcinoma (MC) are compared with 260 pure adenocarcinomas (AC) and 29 adenoacanthomas (AA). There were no basic differences in incidence, clinical history, responses to radiation therapy, and prognosis for any of these three entities. Adenocarcinomas of the endometrium with and without squamous elements should be regarded and approached as any pure AC. There is an overall tendency for endometrial carcinomas to be at an early stage at diagnosis and the five-year survival regardless of pathologic type, stage, grade, myometrial invasion, and therapy is 80%.

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Mixed Adenosquamous Carcinoma of the Endometrium

Cited by 90 publications

References 0 publications

Adenoacanthoma of the endometrium: morphological changes induced by human papillomavirus.

Adenoacanthoma of the endometrium: morphological changes induced by human papillomavirus.

Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma

Adenosquamous carcinoma of the endometrium.An entity with an inherent poor prognosis?

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