Adenocarcinoma of the uterine cervix

Adenocarcinoma of the uterine cervix is a relative uncommon form of cervical cancer. Like the more common squamous cell carcinoma of the cervix, it is associated strongly with the human papilloma virus.

It is also known as endocervical adenocarcinoma and cervical adenocarcinoma.

General

• Adenocarcinoma of the cervix is much less common than squamous dysplasia of the cervix/SCC of the cervix.
• Arises from the endocervical glands.

Microscopic

Features:

• Stromal changes - "desmoplastic stroma/desmoplastic reaction".
  • Fibrosis/streaming cells.
• Gland fusion.
• Glands too deep -- very fuzzy criterion.

Notes:

• AIS changes - similar to colonic dysplasia.
• AIS may occur together with CIN.
  • Not infrequently they (AIS, CIN) occur together - both are due, indirectly, to HPV infection.
• May be difficult to be certain of invasion.
  • A feature suggestive of invasion is cytoplasmic eosinophilia.

DDx:

• Microglandular hyperplasia - NC ratio normal, no nuclear atypia.
• Endocervical adenocarcinoma in situ.
• Villoglandular adenocarcinoma.
• Glassy cell carcinoma.
• Metastatic adenocarcinoma.
  • Endometrioid endometrial carcinoma.
  • Serous endometrial carcinoma.

Images

• 

  Cervical adenocarcinoma - low mag. (WC)

• 

  Cervical adenocarcinoma - intermed. mag. (WC)

• 

  Cervical adenocarcinoma - high mag. (WC)

IHC

Features for diagnosis:

• p16 +ve.
• Ki-67 -- high.

Uterus vs. cervix:

• Cervix (typically): CEA +ve, p16 +ve.
  • ER -ve, PR -ve, vimentin -ve.
• Uterus (typically): vimentin +ve, ER +ve, PR +ve.
  • CEA -ve, p16 -ve.

See also

• Uterine cervix.
• Gynecologic cytopathology.