scholarly journals Cytological variations and typical diagnostic features of endocervical adenocarcinoma in situ: A retrospective study of 74 cases

CytoJournal ◽  
2015 ◽  
Vol 12 ◽  
pp. 8 ◽  
Author(s):  
Takashi Umezawa ◽  
Miyaka Umemori ◽  
Ayana Horiguchi ◽  
Kouichi Nomura ◽  
Hiroyuki Takahashi ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Single Cells ◽  
Adenocarcinoma In Situ ◽  
Endocervical Adenocarcinoma ◽  
Necrotic Tumor ◽  
Papanicolaou Smears ◽  
Typical Type ◽  
Polymorphic Type ◽  
Mitotic Figures

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.

scholarly journals Superficially Spreading Endocervical Adenocarcinoma in situ with Multifocal Microscopic Involvement of the Endometrial Surface: A Case Report with Emphasis on the Potential for Misdiagnosis Based on Endometrial Curettage Specimens

2020 ◽  
Vol 13 (3) ◽  
pp. 1530-1536
Author(s):  
Inwoo Hwang ◽  
Jiyeon Lee ◽  
Kyue-Hee Choi ◽  
Jiheun Han ◽  
Hyun-Soo Kim
Keyword(s):  
Final Diagnosis ◽  
Accurate Diagnosis ◽  
Surface Epithelium ◽  
Apoptotic Bodies ◽  
Small Tumor ◽  
Histological Features ◽  
Endocervical Adenocarcinoma ◽  
Tumor Tissues ◽  
Mitotic Figures

Misdiagnosis of endocervical adenocarcinoma (EAC) as endometrial endometrioid carcinoma (EEC) is one of the major concerns when evaluating endometrial curettage specimens. It is difficult to differentiate EAC involving the endometrium from EEC, particularly when the specimens have only a few small tumor fragments. We report a case of endocervical adenocarcinoma <i>in situ</i> (AIS) with multifocal microscopic involvement of the endometrium. The endometrial curettage specimen obtained from an 82-year-old woman consisted of a large volume of blood and fibrin, with small endometrial tissue fragments showing microscopic foci of atypical glandular proliferation. Based on the presence of complex glands with stratified mucin-poor columnar epithelium and intermediate-grade nuclear atypia, a preoperative diagnosis of grade 1 EEC was made. However, the hysterectomy specimen revealed an endocervical AIS involving the endocervix and low uterine segment. Frequent mitotic figures and apoptotic bodies, characteristic of AIS, were present. The endometrium showed a few microscopic foci of atypical glandular proliferation involving the surface only. Their histological features were similar to those of the endocervical AIS. Immunohistochemically, the atypical glands exhibited block p16 positivity. The final diagnosis was a superficially spreading endocervical AIS with multifocal microscopic involvement of the endometrial surface epithelium. In summary, small tumor tissues in an endometrial curettage may lead to misdiagnosis of AIS or EAC as EEC, especially when the pathologists are unaware of the possibility of microscopic endometrial involvement of AIS or EAC. The origin of the tumor can be correctly determined based on a combination of histological features and immunostaining. Endocervical AIS involving the endometrium should be included in the differential diagnosis of neoplastic glandular lesions in endometrial curettage specimens. An accurate diagnosis in these cases is important because of its significant implications for clinical management.

Isolated Ovarian Recurrence of Endocervical Adenocarcinoma In Situ

2016 ◽  
Vol 32 (3) ◽  
pp. 189-192 ◽  
Author(s):  
Elena B. Pereira ◽  
Lena El Hachem ◽  
Mazdak Momeni ◽  
Richard Eisen ◽  
Herbert Gretz
Keyword(s):  
Adenocarcinoma In Situ ◽  
Endocervical Adenocarcinoma

Endocervical adenocarcinoma in situ: An analysis of cellular features

1997 ◽  
Vol 17 (5) ◽  
pp. 326-332 ◽  
Author(s):  
Charles V. Biscotti ◽  
Margaret A. Gero ◽  
Sean M. Toddy ◽  
Diana F. Fischler ◽  
Kirk A. Easley
Keyword(s):  
Adenocarcinoma In Situ ◽  
Endocervical Adenocarcinoma

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

2006 ◽  
Vol 130 (10) ◽  
pp. 1510-1515 ◽  
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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