![]() ![]() ![]() The histologic features of GAS include clear and pale eosinophilic cytoplasm, distinct cell borders, and immunohistochemical evidence of gastric differentiation (expression of MUC6 and HIK1083). Minimal deviation adenocarcinoma (MDA), also known as adenoma malignum, is a designation that refers to a well-differentiated form of GAS. GAS is defined as a subtype of mucinous adenocarcinoma with gastric differentiation in the 2014 World Health Organization classification of cervical tumors. However, the remaining 5–10% of cervical adenocarcinomas are not associated with HPV infection, and the most common one is gastric-type adenocarcinoma (GAS). More than 90% of cervical adenocarcinomas are caused by high-risk human papillomavirus (HPV) persistent infection, with the most common HPV types as 18, 16 or 45. Therefore, awareness of the morphologic features and immunohistochemical profile of GAS will allow pathologists to recognize and accurately diagnose this rare and aggressive entity. ConclusionsĮndocervical 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. P16 was negative or patchy positive in most cases and p53 mutation was identified in 12 cases (12/21, 57.1%). Immunohistochemically, tumor cells were diffusely positive for CK7, MUC6 and CA-IX, but focally positive for CK20 and CDX2. Ovarian and fallopian tube involvement were identified in 5 and 6 cases, respectively. Fourteen endocervical GAS cases demonstrated mild cytologic atypia, and 9 cases showed moderate to marked cytologic atypia. Cytologically, tall columnar epithelial cells with pale, foamy or vacuolated cytoplasm were mostly common, followed by well-defined cytoplasmic borders. The average age of patients was 51 years old (range from 28 to 73). Clinical characteristics, cytologic/histopathologic findings, and immunohistochemical results were collected and analyzed. MethodsĪ total of 23 patients diagnosed with endocervical GAS/minimal deviation adenocarcinoma (MDA) at Peking University People’s Hospital between 20 were included. This study aimed to evaluate cytologic and clinicopathological features, differential diagnosis of endocervical GAS. Aggressive treatment is justified in patients with pattern C tumors.Endocervical gastric-type adenocarcinoma (GAS) is a rare non-human papillomavirus-associated adenocarcinoma (NHPVA) with morphologic and immunohistochemical features of gastric differentiation. Patients with pattern B tumors rarely presented with metastatic LNs, and sentinel LN examination could potentially identify these patients. This new classification system demonstrated 20.7% of patients (pattern A) with negative LNs, and patients with pattern A tumors can be spared of lymphadenectomy. The 189 (53.7%) remaining patients had pattern C tumors 45 (23.8%) of them had LN metastases. Ninety patients (25.6%) were identified with pattern B tumors (all stage I) only 4 (4.4%) had LN metastases 1 had vaginal recurrence. Using this new system, 73 patients (20.7%) were identified with pattern A tumors (all stage I) none had LN metastases and/or recurrences. Forty-nine (13.9%) cases demonstrated lymph nodes (LNs) with metastatic endocervical carcinoma. Mean patient age was 45 years (range, 20 to 83 y). In total, 352 cases (all FIGO stages) from 12 institutions were identified. Tumors with pattern C showed diffusely infiltrative glands with associated extensive desmoplastic response. Pattern B tumors demonstrated localized destructive invasion defined as desmoplastic stroma surrounding glands with irregular and/or ill-defined borders or incomplete glands and associated tumor cells (individual or small clusters) within the stroma. In short, pattern A tumors were characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture. A new 3-tier pattern-based system to classify endocervical adenocarcinoma was recently presented.
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