Intestinal-type endocervical

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... 

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 18.27 Cytokeratin subsets in primary endocervical-type mucinous tumors (seromucinous tumors). This type of mucinous tumor has a typical mullerian immunophenotype. (A) Endocervical-type mucinous tumors show diffuse strong staining for CK7. (B) In contrast to intestinal-type mucinous tumors, endocervical-type mucinous tumors are CK20-negative. 

Lin X, Lindner JL, Silverman JF, et al. Intestinal type and endocervical-like ovarian mucinous neoplasms are immuno-phenotypically distinct entities. Appl Immunohistochem Mol Morphol. 2008 16 453-458. 

Immunohistochemistry can play an important role in the diagnosis and classification of mucinous tumors of the ovary. Two types of primary mucinous tumors occur in the ovary. Tumors composed of cells with an intestinal phenotype are most common, but a minority of mucinous tumors has an endocervical-like or seromucinous phenotype. These two types of mucinous tumors have different immunophenotypes, and immunostains can be used to differentiate between the two types. Immunostains for cytokeratin or epithelial membrane antigen can help identify foci of microinvasion. 

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