Primary endocervical gastric-type adenocarcinoma: a clinicopathologic and immunohistochemical analysis of 23 cases

Abstract

Background Endocervical gastric-type adenocarcinoma (GAS) is a rare non-human papillomavirus-associated adenocarcinoma (NHPVA) with morphologic and immunohistochemical features of gastric differentiation. This study aimed to evaluate cytologic and clinicopathological features, differential diagnosis of endocervical GAS. Methods A total of 23 patients diagnosed with endocervical GAS/minimal deviation adenocarcinoma (MDA) at Peking University People’s Hospital between 2009 and 2018 were included. Clinical characteristics, cytologic/histopathologic findings, and immunohistochemical results were collected and analyzed. Results The average age of patients was 51 years old (range from 28 to 73). Cytologically, tall columnar epithelial cells with pale, foamy or vacuolated cytoplasm were mostly common, followed by well-defined cytoplasmic borders. Fourteen endocervical GAS cases demonstrated mild cytologic atypia, and 9 cases showed moderate to marked cytologic atypia. Ovarian and fallopian tube involvement were identified in 5 and 6 cases, respectively. Immunohistochemically, tumor cells were diffusely positive for CK7, MUC6 and CA-IX, but focally positive for CK20 and CDX2. P16 was negative or patchy positive in most cases and p53 mutation was identified in 12 cases (12/21, 57.1%). Conclusions Endocervical GAS shows different morphologic and immunological features from endocervical usual type adenocarcinoma, but it may be difficult to be differentiated from metastatic mucinous adenocarcinoma to cervix due to similar morphology and overlapping immunohistochemical profile. Therefore, awareness of the morphologic features and immunohistochemical profile of GAS will allow pathologists to recognize and accurately diagnose this rare and aggressive entity.

Cytomorphologic Features of Gastric-Type Endocervical Adenocarcinoma in Liquid-Based Preparations

“…In addition, Omori et al [28] state that “it is difficult to recognize yellow mucin on LBC because the mucin color becomes paler.” In their report, Omori et al [28] nicely illustrate the difference in mucin color (yellow vs. pink in normal endocervix) in an image which also demonstrates the relatively uniform enlargement of the nuclei compared to the normal endocervical cells. Lu et al [15] report that golden-yellow intracytoplasmic mucin was not noticeable in their series of 11 patients with pretreatment Pap tests (both TP and SP) out of a cohort of 23 GAS cases indicating that, indeed, golden-yellow mucin may not be a particularly sensitive feature for GAS detection, at least in LBC. Of note, only 4/11 Pap tests in their study were originally reported as AGC (favor neoplasia or NOS) while the remaining results were NILM, HSIL, and unsatisfactory, thus underlining the difficulty of GAS detection in cytology [15].…”

“…Lu et al [15] report that golden-yellow intracytoplasmic mucin was not noticeable in their series of 11 patients with pretreatment Pap tests (both TP and SP) out of a cohort of 23 GAS cases indicating that, indeed, golden-yellow mucin may not be a particularly sensitive feature for GAS detection, at least in LBC. Of note, only 4/11 Pap tests in their study were originally reported as AGC (favor neoplasia or NOS) while the remaining results were NILM, HSIL, and unsatisfactory, thus underlining the difficulty of GAS detection in cytology [15]. Yuan et al [24] note that although golden-yellow mucin was seen, it was relatively scanty in the atypical cells thought to represent gastric-type AIS in their study.…”

Gastric‐type endocervical adenocarcinoma and cervical cytology: Experience at a general hospital and review of the literature

“…On cervical cytology specimens, GAS has been reported to show endocervical cells in monolayered and honeycomb sheets with well-defined cell borders, pale vacuolar and/or foamy cytoplasm, and vesicular nuclei with conspicuous nucleoli 4,5,7,16,[18][19][20] . Peripheral palisading mimicking feathering has also been reported 18 .…”

Non‐human papilloma virus associated adenocarcinomas of the cervix uteri. Cytologic features and diagnostic agreement using whole slide digital cytology imaging

“…Regardless of the histological features, these neoplasms share a non‐HPV related carcinogenesis. Therefore, they are not recognized by primary HPV‐screening, and also surrogate biomarkers of oncogenic HPV‐activity (for example p16) are not useful for the diagnosis of these cancers 1‐3 . Conversely, in non‐screening cytology or in primary cytologic screening settings, NHPVAs may occur.…”