Pattern-based classification of invasive endocervical adenocarcinoma, depth of invasion measurement and distinction from adenocarcinoma in situ: interobserver variation among gynecologic pathologists

Background: The sensitivity of Papanicolaou smears for detecting endocervical adenocarcinoma in situ (AIS) is very low. A comprehensive cytological analysis of endocervical AIS is necessary to increase diagnostic accuracy. Methods: The subjects were 74 patients with pathologically-diagnosed AIS. A total of 140 Papanicolaou smears were reviewed to calculate the sensitivity of the Papanicolaou smears for detecting AIS and the incidence of sampling/screening/diagnostic errors. The cytological review was performed by 6 cytotechnologists, and the final cytological diagnosis was obtained at the consensus meeting. We classified the cases into three differentiation types; typical type (well-differentiated AIS), polymorphic type (poorly differentiated AIS), and mixed typical and polymorphic type. Three cytological subtypes (endocervical, endometrioid and intestinal subtypes) of AIS were also analyzed. Results: The sensitivity of the original Papanicolaou smears for the detection of AIS was 44.6%, while that for the detection of AIS and adenocarcinoma was 63.5%. The diagnostic accuracy of AIS increased to 78.5% in the final diagnosis. The common characteristic features were microbiopsies/hyperchromatic crowded groups (HCG) (82.0%) and mitotic figures (72.2%). The appearance of single cells (2.8%) was rare, and all the cervical cytology smears showed no evidence of necrotic tumor diathesis. The most common AIS was the typical type (41 cases, 67.2%) among all cytologically-diagnosed AIS or adenocarcinoma cases (61 cases). Although mixed typical and polymorphic AIS existed in 17 cases (27.9%), pure polymorphic AIS was very rare (3 cases, 4.9%). The endocervical subtype was the most predominant subtype (67.2%), followed by a few mixed subtypes. The important diagnostic keys for AIS cytology are as follows: (1) The appearance of microbiopsies/HCG (single-cell pattern is rare), (2) mitotic figures in the microbiopsies/HCG, (3) a lack of necrotic tumor diathesis in cases with polymorphic AIS, and (4) recognition of typical cytological subtypes. Conclusions: The relatively low diagnostic accuracy AIS was caused by the underestimation of microbiopsies/HCG and the overestimation of polymorphic components. The typical cytological features of AIS are the presence of microbiopsies/HCG with mitotic figures in the absence of necrotic tumor diathesis in specimens containing endocervical samples. The recognition of infrequent AIS subtypes (endometrioid and intestinal subtypes) is also important.

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PTEN Loss and ARID1A Mutation in an HPV-positive Metastatic Adenocarcinoma Diagnosed Almost 18 yr After an Intact Cone Excision for Endocervical Adenocarcinoma In Situ

International Journal of Gynecological Pathology ◽

10.1097/pgp.0000000000000811 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Omonigho Aisagbonhi ◽

Somaye Y. Zare ◽

Farnaz Hasteh ◽

Pratibha Binder ◽

Andres A. Roma ◽

...

Keyword(s):

Adenocarcinoma In Situ ◽

Metastatic Adenocarcinoma ◽

Pten Loss ◽

Endocervical Adenocarcinoma

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Endocervical adenocarcinoma in situ: An analysis of cellular features

Diagnostic Cytopathology ◽

10.1002/(sici)1097-0339(199711)17:5<326::aid-dc4>3.0.co;2-8 ◽

1997 ◽

Vol 17 (5) ◽

pp. 326-332 ◽

Cited By ~ 24

Author(s):

Charles V. Biscotti ◽

Margaret A. Gero ◽

Sean M. Toddy ◽

Diana F. Fischler ◽

Kirk A. Easley

Keyword(s):

Adenocarcinoma In Situ ◽

Endocervical Adenocarcinoma

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A Case of HPV-negative Intestinal-type Endocervical Adenocarcinoma In Situ With Coexisting Multifocal Intestinal and Gastric Metaplasia

The American Journal of Surgical Pathology ◽

10.1097/pas.0000000000000139 ◽

2014 ◽

Vol 38 (2) ◽

pp. 289-291 ◽

Cited By ~ 10

Author(s):

Karen L. Talia ◽

Andrea Cretney ◽

W. Glenn McCluggage

Keyword(s):

Intestinal Type ◽

Adenocarcinoma In Situ ◽

Endocervical Adenocarcinoma ◽

Gastric Metaplasia

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Evolution of endocervical adenocarcinoma in situ: A retrospective case series study

Clinical Obstetrics Gynecology and Reproductive Medicine ◽

10.15761/cogrm.1000195 ◽

2017 ◽

Vol 3 (5) ◽

Author(s):

José Y ◽

Borque A ◽

Rubio P ◽

Baquedano L ◽

Lanzón A ◽

...

Keyword(s):

Case Series ◽

Adenocarcinoma In Situ ◽

Retrospective Case ◽

Endocervical Adenocarcinoma ◽

Retrospective Case Series ◽

Case Series Study ◽

Series Study

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Mucinous Expression in Benign and Neoplastic Glandular Lesions of the Uterine Cervix

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1510-meiban ◽

2006 ◽

Vol 130 (10) ◽

pp. 1510-1515 ◽

Cited By ~ 3

Author(s):

Allyson C. Baker ◽

Isam Eltoum ◽

Rebecca O. Curry ◽

Cecil R. Stockard ◽

Upender Manne ◽

...

Keyword(s):

Epithelial Cells ◽

Uterine Cervix ◽

Adenosquamous Carcinoma ◽

Adenocarcinoma In Situ ◽

Endocervical Adenocarcinoma ◽

Mucin Expression ◽

The Difference ◽

Almost All ◽

Endometrial Carcinomas

Abstract Context.—Mucins are glycoproteins produced by both normal and neoplastic glandular epithelial cells including endocervix. Objective.—To determine the expression of mucins in uterine cervical glandular lesions and whether mucin expression correlates with the nature and origin of the glandular lesions. Design.—Antibodies to MUC1, MUC2, MUC4, and MUC5AC were applied on 52 cases including 14 endocervical adenocarcinomas (including 4 adenosquamous carcinomas), 9 endometrial carcinomas (8 endometrioid adenocarcinomas and 1 adenosquamous carcinoma), 8 adenocarcinoma in situ (AIS), 2 glandular dysplasias, 6 tubal metaplasias, 10 microglandular hyperplasias, and 3 normal endocervix. The presence of any staining was considered positive. Results.—All benign endocervical epithelia, including tubal metaplasia and microglandular hyperplasia, expressed MUC1, MUC4, and MUC5AC but not MUC2. Almost all endocervical AIS and carcinomas and all endometrial adenocarcinomas expressed MUC1; the exceptions were 2 cases of endocervical adenocarcinoma and 1 case of adenosquamous carcinoma of the endocervix. MUC2 staining was noted in 25%, 40%, and 22% of AIS, endocervical adenocarcinomas, and endometrial adenocarcinomas, respectively. About 38% of AIS, 75% of endocervical adenocarcinomas, and 44% of endometrial adenocarcinomas expressed MUC4. Half of AIS, most of endocervical adenocarcinomas, and 22% of endometrial adenocarcinomas expressed MUC5AC. The difference in MUC4 and MUC5AC expression between benign endocervical lesions and AIS and the difference in MUC5AC expression between endocervical and endometrial neoplasms were statistically significant. Conclusions.—Mucin expressions differed among benign endocervical lesions and AIS and among endocervical and endometrial malignancies. These results suggest that mucin staining may potentially be helpful in differentiating various uterine cervical glandular lesions.

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