![]() ![]() There are excellent comprehensive reviews and original studies addressing these particular topics and the reader is referred to a selection of these references for the clinicopathologic details provided by a more traditional approach. The most commonly encountered diagnostic problems include the following: (1) diagnosing invasion for high-risk HPV-related (usual type) endocervical adenocarcinomas of usual type, particularly for the common well differentiated and often superficial forms which must be distinguished from extensive endocervical adenocarcinoma in situ (AIS) (2) distinguishing high-risk HPV-related endocervical adenocarcinomas from endometrial endometrioid carcinomas and their related subtypes, which include those with mucinous and metaplastic-type differentiation and (3) distinguishing benign mucinous endocervical glandular proliferations, including the various forms of endocervical glandular hyperplasia, from gastric-type mucinous endocervical adenocarcinomas, particularly the very well differentiated minimal deviation type. 1, 2, 3, 4, 5, 6, 7, 8 Both types pose a number of diagnostic challenges for practicing pathologists. ![]() The former, which represent the vast majority, are referred to as endocervical adenocarcinomas of usual type and the latter are dominated by the gastric-type mucinous adenocarcinomas, which include minimal deviation adenocarcinoma. The current review provides practical points and numerous illustrative examples to guide pathologists in addressing these diagnostic challenges in routine practice.Įndocervical adenocarcinomas can be classified into two main types of tumors, namely, those related to high-risk human papillomavirus (HPV) and those unrelated to high-risk HPV. Commonly encountered diagnostic problems concerning these endocervical adenocarcinomas include: (1) diagnosing invasion for endocervical adenocarcinomas of usual type, particularly superficial forms which must be distinguished from extensive endocervical adenocarcinoma in situ (2) distinguishing high-risk human papillomavirus-related endocervical adenocarcinomas from endometrial endometrioid carcinomas and (3) distinguishing benign/hyperplastic mucinous endocervical glandular proliferations from gastric-type mucinous endocervical adenocarcinomas, particularly minimal deviation adenocarcinoma. The former, representing the vast majority, are referred to as endocervical adenocarcinomas of usual type and the latter are dominated by the gastric-type mucinous adenocarcinomas. Aggressive treatment is justified in patients with pattern C tumors.Endocervical adenocarcinomas can be classified into two main types of tumors, namely, those related to high-risk human papillomavirus and those unrelated to high-risk human papillomavirus. Patients with pattern B tumors rarely presented with metastatic LNs, and sentinel LN examination could potentially identify these patients. This new classification system demonstrated 20.7% of patients (pattern A) with negative LNs, and patients with pattern A tumors can be spared of lymphadenectomy. The 189 (53.7%) remaining patients had pattern C tumors 45 (23.8%) of them had LN metastases. Ninety patients (25.6%) were identified with pattern B tumors (all stage I) only 4 (4.4%) had LN metastases 1 had vaginal recurrence. Using this new system, 73 patients (20.7%) were identified with pattern A tumors (all stage I) none had LN metastases and/or recurrences. Forty-nine (13.9%) cases demonstrated lymph nodes (LNs) with metastatic endocervical carcinoma. Mean patient age was 45 years (range, 20 to 83 y). In total, 352 cases (all FIGO stages) from 12 institutions were identified. Tumors with pattern C showed diffusely infiltrative glands with associated extensive desmoplastic response. Pattern B tumors demonstrated localized destructive invasion defined as desmoplastic stroma surrounding glands with irregular and/or ill-defined borders or incomplete glands and associated tumor cells (individual or small clusters) within the stroma. In short, pattern A tumors were characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture. A new 3-tier pattern-based system to classify endocervical adenocarcinoma was recently presented. ![]()
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