Villoglandular Papillary Adenocarcinoma of the Uterine Cervix in a Pregnant Woman: A Case Report and Review of Literature

Dede, Murat; Deveci, Güzin; Deveci̇, Mustafa; Yenen, Müfit Cemal; Göktolga, Ümit; Dılek, Saffet; Günhan, Ömer

doi:10.1620/tjem.202.305

Cited by 17 publications

(14 citation statements)

References 19 publications

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“…The conservative management of VGPA is widely recognized due to its favorable outcome and young patient age, particularly in those individuals who want to preserve their fertility (2,3,11). Nevertheless, risk factors of a poor outcome, including lymphovascular space invasion, lymph node metastasis, tumor recurrence and even mortality, have been reported in several cases (4)(5)(6)(7)(8)(12)(13)(14)(15)(16). Etiologically, the association between HPV infection and VGPA has been demonstrated by certain studies (1,17,18).…”

Section: Introductionmentioning

confidence: 99%

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature

et al. 2015

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Abstract. To investigate the clinicopathological features, management and prognosis of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix, the current study presents 4 cases of VGPA of the uterine cervix. The median age of the patients was 55 years (range, 47-70 years), with all 4 patients presenting with stage Ib disease. Human papillomavirus (HPV) infection was detected in 3 patients; this was mainly HPV-16. No history of oral contraceptive use was found in these cases. While 2 of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, 1 patient underwent a radical hysterectomy with bilateral pelvic lymphadenectomy and the remaining patient received a simple total hysterectomy plus post-operative radiotherapy. Of these patients, only 1 had been correctly diagnosed pre-operatively. In 2 patients, the biopsy results had been interpreted as cervical adenocarcinoma, and in the third, the biopsy result was of cervical intraepithelial neoplasia. All 4 patients presented with cervical wall invasion, including invasion of the inner two-thirds in 1 patient. No lymphovascular space invasion or lymph node metastasis was detected. The follow-up time ranged from 49 to 83 months (median, 64 months), and the patients are currently alive and well, with no evidence of recurrent disease. Taking these results as a whole, VGPA is an uncommon type of cervical adenocarcinoma, characterized by its excellent prognosis. HPV infection is associated with the molecular pathogenesis of VGPA, while oral contraceptive use can be excluded. As the disease has a low pre-operative diagnostic accuracy, frequent cervical wall invasion and concomitant lesions, conservative treatment strategies should be carefully considered.

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Section: Introductionmentioning

confidence: 99%

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature

et al. 2015

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“…For such reasons, young women can be treated conservatively, with only a conization. However, deep stromal invasion, lymph node metastases (11Y13), and even death of patient have been reported (4,14). These findings suggest that correct procedures should be adopted in the pathological examination of the VGPA.…”

Section: Discussionmentioning

confidence: 99%

Villoglandular Adenocarcinoma of the Cervix

Giordano

D'Adda²,

Gnetti³

et al. 2007

International Journal of Gynecological Pathology

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In this paper, we report 2 new cases of villoglandular papillary adenocarcinoma (VGPA) of the cervix, a rare, well-differentiated form of cervical adenocarcinoma. Both patients were without medical complications or history of oral contraceptive use and were nonsmokers. Extended hysterectomy was performed in both cases. Morphological criteria for a correct pathological diagnosis were emphasized. Immunohistochemical analysis was performed to clarify the phenotype of the neoplasms. Moreover, for the first time, we probed to establish if VGPA could be correlated to human papilloma virus (HPV) and herpes virus (HSV) types 1 and 2, using polymerase chain reaction amplification of tumoral DNA. Both neoplasms showed positivity for B72.3, Ca-125, carcinoembryonic antigen, keratin 7, and p16(INK4a) protein. Vimentin, P53, estrogen, and progesterone receptors, instead, were negative. Molecular study by polymerase chain reaction amplification of tumor DNA revealed a strong positive signal for HPV-DNA and no signal for HSV-DNA. It is reasonable to conclude that our cases of VGPA, in accordance with other examples reported in literature, are due to HPV infection. Behavioral cofactors, such as HSV infection (types 1 and 2), oral contraceptive use and smoking, involved in the pathogenesis of other cervical malignancies, can be excluded for the present cases.

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“…Using the criteria outlined above as a justification for conservative management, at least one patient with obturator lymph node metastases would have been missed [5]. Additionally, Dede et al [4] recently described another patient with stage 1B1 WDVGA who was initially managed with a radical hysterectomy. There was no lymphovascular invasion and apparently no stromal invasion ("no invasion focus of atypical small gland in the wall of the cervix was noticed").…”

Section: Discussionmentioning

confidence: 99%

“…There was no lymphovascular invasion and apparently no stromal invasion ("no invasion focus of atypical small gland in the wall of the cervix was noticed"). This patient would experience multiple pelvic recurrences over the ensuing 5 years and eventually died of her disease [4]. This is another patient who could have been managed with conservative treatment alone based on the above criteria.…”

Section: Discussionmentioning

confidence: 99%

Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix with a focal high-grade component: is there a need for reassessment?

Fadare

Zheng

2005

Virchows Arch

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Well-differentiated villoglandular adenocarcinoma of the uterine cervix is characterized by an exophytic growth pattern with variably sized papillae that are lined by stratified columnar cells with no more than moderate cytologic atypia. Based on the favorable outcomes in most of the previously reported cases, it has been suggested that some patients with this subtype may be managed conservatively. The case described herein is an otherwise prototypical well-differentiated villoglandular adenocarcinoma but which was associated with a 4.9-mm focus of poorly differentiated carcinoma at its invasive edge. A review of the literature revealed a variety of findings that suggests a need to reassess the potential morphologic and biologic spectrum of this group of tumors. Five of the approximately 89 reported cases were associated with a higher-grade component of the same or a different histologic subtype. At least one patient with apparently stage 1A1 disease was found to have a positive lymph node. Another patient with stage 1B1 disease but no stromal invasion died of her disease following multiple recurrences. Finally, the frequency of lymphovascular invasion and/or lymph node involvement in recent series far exceeds what was found in the two original series. Our case suggests that well-differentiated villoglandular adenocarcinoma is not a diagnosis that should be unequivocally rendered on a small biopsy since other components may be present and the patients may be undertreated. We urge caution when conservative management (cone biopsy alone when margins are negative and there is no lymphovascular invasion) is offered to patients with this tumor since knowledge about its true biologic spectrum appears to still be in evolution.

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Villoglandular Papillary Adenocarcinoma of the Uterine Cervix in a Pregnant Woman: A Case Report and Review of Literature

Cited by 17 publications

References 19 publications

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature

Villoglandular Adenocarcinoma of the Cervix

Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix with a focal high-grade component: is there a need for reassessment?

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