Endocervical adenocarcinoma

Vimentin coexpression is especially useful in differentiating endometrial endometrioid carcinomas in uterine curettage specimens from endocervical adenocarcinomas including the endometrioid variant of endocervical adenocarcinoma. Endometrial endometrioid carcinomas immunostain strongly for vimentin, but endocervical carcinomas rarely stain (weak focal staining in up to 13% of endocervical carcinomas). i > i However, with the current antigen retrieval techniques, moderate to occasionally strong vimentin expression may be seen in endocervical carcinomas, and a panel approach is more useful in this distinction. ... 

Siami K, McCluggage WG, Ordonez NG, et al. Thyroid transcription factor-1 expression in endometrial and endocervical adenocarcinomas. Am Surg Pathol. 2007 31 1759-1763. 

Elishaev E, Gilks CB, Miller D, et al. Synchronous and metachronous endocervical and ovarian neoplasms evidence supporting interpretation of the ovarian neoplasms as metastatic endocervical adenocarcinomas simulating primary ovarian surface epithelial neoplasms. Am J Surg Pathol. 2005 29 281-294. 

Mesonephric duct remnants may be found in the deep wall of cervix specimens. Sometimes, hyperplasia may be pronounced and raise concern for minimal deviation type endocervical adenocarcinoma. Apical expression of CD 10 is common in these remnants, as is expression by the intraluminal secretions. CD 10, however, is not pathognomonic for mesonephric differentiation because some endocervical and endometrial adenocarcinomas may express CDIO. Minimal deviation type endocervical adenocarcinoma, however, lacks CDIO expression. Variable expression of pi6 is reported in mesonephric remnants and may lead to misinterpretation as endocervical adenocarcinoma however, MIBl is not increased. ER, PR, and CEA are generally negative. The immuno-phenotype is similar in mesonephric adenocarcinoma as well. " ... 

Endocervical adenocarcinoma (AIS) is distinguished from endocervical glandular metaplasias, hyperplasia, and endometriosis by increased MIBl and by strong diffuse pi 6 and CEA expression. 

Primary endocervical adenocarcinoma is usually positive for pi 6 and CEA and negative for vimentin and ER, while primary endometrial adenocarcinoma is usually the converse. 

Intestinal-type endocervical adenocarcinoma and AIS contain goblet cells and intestinal type epithelium and may be mistaken for spread of primary intestinal adenocarcinoma. The intestinal marker CDX2 is expressed in intestinal type endocervical adenocarcinoma and AIS as well as in some non-intestinal types (Fig. 18.10). Therefore CDX2 does not help define site of origin. Instead, CK7, CK20, and pl6 should be used. Whereas primary endocervical adenocarcinoma expresses CK7 and pl6 but not CK20, the converse... 

Diagnosis of minimal deviation endocervical adenocarcinoma can be challenging since the cytologic and architectural features of this tumor can be subtle. Robust forms of lobular or diffuse endocervical glandular hyperplasia or deep endocervical glands may mimic minimal deviation adenocarcinoma. A subtle type of endocervical... 

FIGURE 18.8 Endocervical adenocarcinoma in situ may mimic reactive, inflamed surface epithelium (A) (H E) however it is distinguished by diffuse MIB1 expression (B) and diffuse pi 6 expression (C). These markers highlight the typical abrupt transition between normal and neoplastic epithelium. 

FIGURE 18.9 Primary endocervical adenocarcinoma may mimic primary endometriai endometrioid adenocarcinoma (A). (H E.) Monocionai CEA (B) and pi 6 (C) are diffuseiy and strongiy expressed. Estrogen receptor (D) and vimentin (E) are not expressed, aithough the stroma may be vimentin positive. Primary endometriai adenocarcinoma typicaiiy exhibits the converse pro-fiie for these four markers, aithough overiap may occur in some cases. 

Vimentin, an intermediate filament, is expressed in mesenchymal tissues, normal proliferative endometrial epithelial cells, and in the majority of endometrial carcinomas.jj g coexpression of vimentin and low molecular weight cytokeratin can aid in the differential diagnosis of an endocervical versus an endometrial adenocarcinoma. 

FIGURE 18.10 Intestinal-type endocervical adenocarcinoma with prominent goblet cells (A) (H E) may resemble primary intestinal adenocarcinomas that spread to the cervix. CDX2 (B) is expressed in the nuclei of this variant of endocervical adenocarcinoma and therefore should not be used to determine site of origin. CK7, CK20, and pi 6 should be used instead. 

FIGURE 18.11 Minimal deviation endocervical adenocarcinoma consists of a deeply invasive, haphazardly infiltrative proliferation of bland endocervical glands that, in a small tissue sampling, may mimic endocervical glandular hyperplasia or mesonephric remnants (A). (H E.) Some cases may express CEA (B), which is not expressed by its benign mimics. 

Endometrial carcinomas with mucinous, squamous, transitional, neuroendocrine, and undifferentiated features have been described, but information about the immunophenotype of squamous cell, transitional cell, and small cell carcinomas (excluding case reports and small series) is hard to obtain. Data concerning the immunophenotype of mucinous carcinoma center mainly on its distinction from microglandular hyperplasia and endocervical adenocarcinoma, which we have discussed earlier in this chapter. 

McCluggage WG, Oliva E, Herrington CS, et al. CDIO and cal-retinin staining of endocervical glandular lesions, endocervical stroma and endometrioid adenocarcinomas of the uterine corpus CDIO positivity is characteristic of, but not specific for, mesonephric lesions and is not specific for endometrial stroma. Histopathology. 2003 43 144-150. 

Marques T, Andrade LA, Vassallo J. Endocervical tubal metaplasia and adenocarcinoma in situ Role of immunohistochem-istry for carcinoembryonic antigen and vimentin in differential diagnosis. Histopathology. 1996 28 549-550. 

McCluggage WG, Maxwell P, McBride HA, et al. Monoclonal antibodies Ki-67 and MIBl in the distinction of tuboendometri-al metaplasia from endocervical adenocarcinoma and adenocarcinoma in situ in formalin-fixed material. Int J Gynecol Pathol. 1995 14 209-216. 

Ansari-Lari MA, Staebler A, Zaino RJ, et al. Distinction of endocervical and endometrial adenocarcinomas Immunohistochemical pi6 expression correlated with human papillomavirus (HPV) DNA detection. Am J Surg Pathol. 2004 28 160-167. 

Castrillon DH, Lee KR, Nucci MR. Distinction between endometrial and endocervical adenocarcinoma An immunohistochemical study. Int J Gynecol Pathol. 2002 21 4-10. 

Kamoi S, Al-Juboury MI, Akin MR, et al. Immunohistochemical staining in the distinction between primary endometrial and endocervical adenocarcinomas Another viewpoint. Int J Gynecol Pathol. 2002 21 217-223. 

McCluggage WG, Jenkins D. pl6 immunoreactivity may assist in the distinction between endometrial and endocervical adenocarcinoma. Int J Gynecol Pathol. 2003 22 231-235. 

Mikami Y, Kiyokawa T, Hata S, et al. Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions A possible link between lobular endocervical glandular hyperplasia/pyloric gland metaplasia and adenoma malignum . Mod Pathol. 2004 17 962-972. 

Xu JY, Hashi A, Kondo T, et al. Absence of human papillomavirus infection in minimal deviation adenocarcinoma and lobular endocervical glandular hyperplasia. Int J Gynecol Pathol. 2005 24 296-302. 

Vang R, Gown AM, Farinola M, et al. pl6 expression in primary ovarian mucinous and endometrioid tumors and metastatic adenocarcinomas in the ovary Utility for identification of metastatic HPV-related endocervical adenocarcinomas. Am J Surg Pathol. 2007 31 653-663. 

Ronnett BM, Yemelyanova AV, Vang R, et al. Endocervical adenocarcinomas with ovarian metastases Analysis of 29 cases with emphasis on minimally invasive cervical tumors and the ability of the metastases to simulate primary ovarian neoplasms. Am J Surg Pathol. 2008 32 1835-1853. 

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