Cytologic Features of Villoglandular Adenocarcinoma of the Uterine Cervix - A Report of Two Cases -

자궁목 융모샘 샘암종의 세포 소견 -2예 보고-

  • Kim, Bohng-Hee (Department of Pathology, Dankook University Hospital)
  • 김봉희 (단국대학교병원 병리과)
  • Published : 2006.09.30

Abstract

Villoglandular adenocarcinoma of uterine cervix has recently been described, and is characterized by good prognosis and occurrence in young women, except a small number of cases. Morphologically, it exclusively shows villoglandular growth and mild to moderate nuclear atypia, the cytologic diagnoses have been frequently missed due to interpretation error. We report here on the cytologic findings of two cases, and both cases were not diagnosed as adenocarcinoma before punch biopsy. One of these cases showed previously described characteristic features such as high cellularity and large tissue fragments with long villous fronds lined by columnar cell with mild nuclear atypia. The other showed moderate cellularity of somewhat smaller clusters without long villous structures. The clusters showed marked nuclear overlapping and the nuclei showed distinct moderate atypia with hyperchromasia and coarse chromatin pattern. The nucleoli were indistinct. Recognition of these features will be helpful to avoid underdiagnosis as a benign lesion, although diagnosis is still difficult in a portion of the cases.

Keywords

References

  1. Young RH, Scully RE. Villoglandular papillary adenocarcinoma of the uterine cervix. a clinicopathologic analysis of 13 cases. Cancer 1989;63:1773-9 https://doi.org/10.1002/1097-0142(19900501)63:9<1773::AID-CNCR2820630920>3.0.CO;2-J
  2. Ballo MS, Silverberg SG, Sidawy MD. Cytologic features of well-differentiated villoglandular adenocarcinoma of the cervix. Acta Cytol 1996;40:536-40 https://doi.org/10.1159/000333911
  3. Novotny DB, Ferlisi P. Villoglandular adenocarcinoma of the cervix: cytologic presentation. Diagn Cytopathol 1997;17:383-7 https://doi.org/10.1002/(SICI)1097-0339(199711)17:5<383::AID-DC13>3.0.CO;2-J
  4. Chang WC, Matisic JP, Zhou C, Thomson T, Clement PB, Hayes MM. Cytologic features of villoglandular adenocarcinoma of the uterine cervix. Cancer(Cancer Cytopathol) 1999;87:5-11 https://doi.org/10.1002/(SICI)1097-0142(19990225)87:1<5::AID-CNCR2>3.0.CO;2-D
  5. Khunamornpong S, Siriaunkgul S, Suprasert P. Welldifferentiated villoglandular adenocarcinoma of the uterine cervix: cytomorphologic observation of five cases. Diag Cytopathol 2002;26:10-4 https://doi.org/10.1002/dc.10028
  6. Utsugi K, Shimizu Y, Akiyama F, Umezawa S, Hasumi K. Clinicopathologic features of villoglandular papillary adenocarcinoma of the uterine cervix. Gynecologic Oncology 2004;92:64-70 https://doi.org/10.1016/j.ygyno.2003.10.020
  7. Kaku T, Kamura T, Shigematsu T, et al. Adenocarcinoma of the uterine cervix with predominantly villoglandular papillary growth pattern. Gynecologic Oncology 1997;64:147-52 https://doi.org/10.1006/gyno.1996.4539
  8. Jones MW, Silverberg SG, Kurman RJ. Well-differentiated villoglandular adenocarcinoma of the uterine cervix: a clinicopathological study of 24 cases. Int J Gynecol Pathol 1993;12:1-7 https://doi.org/10.1097/00004347-199301000-00001
  9. Dede M, Deveci G, Deveci MS, et al. Villoglandular papillary adenocarcinoma of the uterine cervix in a pregnant woman: a case report and review of literature. Tohogu J Exp Med 2004;202:305-10 https://doi.org/10.1620/tjem.202.305
  10. Macdonald RD, Kirwan J, Hayat K, Herrington CS, Shawki H. Villoglandular adenocarcinoma of the cervix: clarity is needed on the histological definition for this difficult diagnosis. Gynecologic Oncology 2006;100:192-4 https://doi.org/10.1016/j.ygyno.2005.07.133
  11. Heron DE, Axtell A, Gerszten K, et al. Villoglandular adenocarcinoma of the cervix recurrent in an episiotomy scar: a case report in a 32-year-old female. Int J Gynecol Cancer 2005;15:366-71 https://doi.org/10.1111/j.1525-1438.2005.15231.x
  12. Garcea A, Nunns D, Ireland D, Brown L. A case of villoglandular papillary adenocarcinoma of the cervix with lymph node metastasis. BJOG 2003;110:627-9 https://doi.org/10.1046/j.1471-0528.2003.02097.x
  13. Khunamornpong S, Maleemonkol S, Siriaunkgul S, Pantusart A. Well-differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis. J Med Assoc Thai 2001;84:882-8
  14. Fadare O, Zheng W. Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix with a focal high-grade component: is there a need for reassessment? Virchows Arch 2005;447:883-7 https://doi.org/10.1007/s00428-005-0030-3
  15. Bouman A, Oosterhuis GJ, Naudin ten Cate L, van Doorn GA. Villoglandular papillary adenocarcinoma of the cervix Beware of a wolf in sheep's clothing. Eur J Obstet Gyncol Reprod Biol 1999;87:183-9 https://doi.org/10.1016/S0301-2115(99)00106-2
  16. Collinet P, Prolongeau JF, Vaneecloo S. Villoglandular papillary adenocarcinoma of the uterine cervix. Eur J Obstet Gyncol Reprod Biol 1999;86:101-3 https://doi.org/10.1016/S0301-2115(99)00047-0
  17. Ajit D, Dighe S, Gujral S. Cytologic features of villoglandular adenocarcinoma of the cervix. Acta Cytol 2004;48:288-9
  18. Reale D, Vitullo G, Di Virgilio M, Trubiani O, Pizzicannella G. Villoglandular adenocarcinoma of uterine cervix: a case report. Pathologica 2001;93:128-31
  19. Burja IT, Thompson SK, Sawyer Jr WL, Shurbaji MS. Atypical glandular cells of undetermined significance on cervical smears. a study with cytohistologic correlation. Acta Cytol 1999;43:351-6 https://doi.org/10.1159/000331080
  20. DiTomasso JP, Ramzy I, Mody DR. Glandular lesions of the cervix. validity of cytologic criteria used to differentiate reactive changes, glandular intraepithelial lesions and adenocarcinoma. Acta Cytol 1996;40:1127-35 https://doi.org/10.1159/000333970
  21. Raab SS, Isacson C, Layfield LJ. Atypical glandular cells of undetermined significance. cytologic criteria to separate clinically significant from benign lesions. Am J Pathol 1995;104:574-82
  22. Gray W, Mckee GT. Diagnostic cytopathology, 2nd ed. Churchill Livingstone, 2003:660-832
  23. Peralta-Venturino MN, Purslow MJ, Kini SR. Endometrialcells of the 'lower uterine segment' (LUS) in cervical smears obtained by endocervical brushings:a source of potential diagnostic pitfall. Diagn Cytopathol 1995;12:263-71 https://doi.org/10.1002/dc.2840120315
  24. Fadare O, Ghofrani M, Chacho MS, Parkash V. The significance of benign endometrial cells in cervicovaginal smears. Adv Anat Pathol 2005;12:274-87 https://doi.org/10.1097/01.pap.0000184174.76221.eb
  25. Lee KR, Miner LJ, Granter SR. Papanicolaou smear sensitivity for adenocarcinoma in situ of the cervix. a study of 34 cases. Am J Clin Pathol 1997;107:30-5 https://doi.org/10.1093/ajcp/107.1.30
  26. Drijkoningen M, Meertens B, Lauweryns J. High grade squamous intraepithelial leison(CIN3) with extension into the endocervical clefts. difficulty of cytologic differentiation from adenocarcinoma in situ. Acta Cytol 1996;40:889-94 https://doi.org/10.1159/000333998