Well-Differentiated Villoglandular Adenocarcinoma of the Uterine Cervix: Assessment of Cytological Features by Histological Subtypes

Abstract

Objective: Well-differentiated villoglandular adenocarcinoma (VGA) of the cervix involves papillae lined by different types of epithelial cells that are histologically subclassified into endocervical, endometrioid, or intestinal subtypes. The objective of the current study was to evaluate the definite cytological features of VGA by histological subtype. Study Design: We examined 8 cervical smears from patients confirmed to have pure VGA and classified them into the 3 histological subtypes. Results: The cervical smears were highly cellular and had a relatively clean background. The nuclei had minimal anisonucleosis and fine granular chromatin with almost inconspicuous nucleoli. The characteristic findings of the endocervical type were a palisading arrangement consisting of columnar or spindle-shaped cells with apical or elongated nuclei. Small but clear nucleoli were identified only in the endocervical type. In the endometrioid type, tumor cells consisted of cohesive sheets with smooth edges and very round nuclei. Cytoplasmic vacuolation was never observed in the endometrioid type. The tumor cells in the intestinal type were prominent with abundant cytoplasmic mucin. Conclusions: We demonstrated that the cytological features of this tumor can vary depending on the histological subtype and one should be aware of these features in order to improve diagnostic accuracy.

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

“…However, Young and Scully (2) reported that only 1 out of 13 patients with VGPA had a history of oral contraceptive use. Giordano et al (1) and Hagiwara et al (6) reported that no patient had taken oral contraceptives prior to diagnosis. In the present cases, all 4 patients denied a history of oral contraceptive use.…”

“…The disease was described for the first time by Young and Scully (2) in 1989, and predominantly affects young women (2)(3)(4)(5)(6)(7). Based on its infrequent lymphovascular space invasion and lymph node metastasis, VGPA is generally considered to have relatively indolent behavior and an excellent prognosis compared with other types of cervical adenocarcinomas (2)(3)(4)(8)(9)(10).…”

“…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).…”

“…Etiologically, the association between HPV infection and VGPA has been demonstrated by certain studies (1,17,18). Controversy remains over whether oral contraceptive use plays a role in the progress of VGPA (1,3,6).…”

Practical issues related to uterine pathology: in situ and invasive cervical glandular lesions and their benign mimics: emphasis on cytology–histology correlation and interpretive pitfalls

“…It therefore has a more favorable outcome than the usual endocervical type, and in this younger population more likely to desire fertility, can be managed conservatively via cone excision only, if all of the above criteria are met, no conventional adenocarcinoma is present, and if the margins are free of disease, and no lymphovascular invasion is identified. Cytologically, villoglandular adenocarcinoma presents as dense three-dimensional groups, often with bulbous projections 21 (Figure 12). Mucinous adenocarcinoma is also uncommon but has more frequently been reported in the Japanese population (up to 25% of endocervical adenocarcinoma).…”