Cytologic and cytochemical features of adenoma malignum of the uterine cervix.

Division of Clinical Pathology, Nagano Cancer Detection Center, Matsumoto, Japan.
Cancer (Impact Factor: 4.9). 11/1999; 87(5):245-53.
Source: PubMed

ABSTRACT We previously reported that adenoma malignum (the mucinous type of minimal deviation adenocarcinoma [mucinous MDA]) of the uterine cervix expresses gastric phenotypes. The application of immunocytochemistry using HIK1083, a monoclonal antibody for gastric gland mucous cell mucin, enabled us to identify cellular clusters derived not only from typical lesions of mucinous MDA and less well differentiated lesions but also from gastric metaplasia. In this study, we tried to clarify the cellular features of such clusters in cervical and endometrial smears.
Twelve cases of mucinous MDA were studied. Papanicolaou stain and immunostaining with HIK1083 were performed on histologic and cytologic slides, including cervical and endometrial smears, decolorized smear slides, imprint slides of the tumors, and imprint slides of normal endocervical and gastric mucosa.
Cellular clusters derived from metaplastic lesions, typical lesions, and less well differentiated lesions were found in 9, 4, and 2 cases, respectively. The cellular clusters derived from the metaplastic lesions lacked atypia but resembled those from gastric mucosa. Those derived from the typical lesions showed slight atypia. The cytoplasmic mucins of these cellular clusters, which were positive for HIK1083, were stained yellowish-orange by Papanicolaou stain, whereas those of normal endocervical cells were negative for HIK1083 and were stained pinkish by Papanicolaou stain.
Yellowish-orange staining of cytoplasmic mucins by the Papanicolaou method is an important diagnostic clue aiding identification of mucinous MDA and related lesions by cytology. Moreover, immunostaining with HIK1083 is a useful tool in the diagnosis of these lesions by cytology as well as by histology. Cancer (Cancer Cytopathol)

  • [Show abstract] [Hide abstract]
    ABSTRACT: Rare entities in the Pap test, which include neoplastic and non-neoplastic conditions, pose challenges due to the infrequent occurrence of many of these entities in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls to be aware of in the Pap test. For example, cases with adenoma malignum (AM) have been called benign. Recognition of these conditions can help correctly interpret Pap tests as abnormal and thereby ensure that patients get appropriately diagnosed. In this paper, we illustrate and discuss selected uncommon primary neoplastic lesions of the cervix and the vagina that may be seen in Pap test, with a focus on cytomorphology, differential diagnosis and the role of possible ancillary studies. These cases include high-grade squamous intraepithelial lesion cells with small cell morphology; small cell carcinoma; large neuroendocrine carcinoma; glassy cell carcinoma; AM; malignant mixed Müllerian tumor; clear cell carcinoma and primary malignant melanoma. Recognition of these rare variants/neoplasms is important so that involved Pap tests are not diagnosed as benign and that patients with these conditions get additional follow-up.
    CytoJournal 01/2013; 10(1):17.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Adenoma malignum (AM) of the cervix is a rare disease and it is difficult to diagnose due to the deceptively benign appearance of the tumor cells. These lesions have mucin-rich cystic lesions and are usually situated deep in the cervix. Since AM is very rare, standard screening tests, diagnostic tools and treatments have not yet been established. Radiologically, it mimics multiple nabothian cysts as a benign-looking tumor. Histologically, AM is a well-differentiated adenocarcinoma and could be misdiagnosed as a benign lesion. These findings make a preoperative diagnosis of AM difficult and can result in surgery being performed based on a misdiagnosis. We report here on four cases of pathologically confirmed AM.
    World Journal of Surgical Oncology 07/2013; 11(1):168. · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Minimal deviation adenocarcinoma (MDA), also known as adenoma malignum of the uterine cervix, accounts for only ~1% of uterine cervical adenocarcinomas. Adenoma malignum of the uterine cervix was initially described by Gusserow in 1870. Using magnetic resonance imaging (MRI), MDA appears as multilocular lesions with solid components that extend from the endocervical glands to the deep cervical stroma. Cytological evaluation and biopsies have low detection rates, therefore, it is difficult to diagnose MDA accurately prior to treatment. The current study describes a rare case of MDA that was difficult to differentiate from endometrial adenocarcinoma of the corpus uteri preoperatively, as the endometrial biopsy results suggested a well-differentiated endometrioid adenocarcinoma and MRI did not show typical images for MDA. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed under the diagnosis of endometrial cancer, and the mass was subsequently diagnosed as MDA of the uterine cervix by pathological examination of the hysterectomy specimen. Postoperatively, although two types of adjuvant chemotherapy were performed, the remaining tumor continued to grow, causing obstruction of the bilateral ureters and leading to bilateral hydronephrosis. The patient is currently alive with the disease 10 months following the surgery.
    Oncology letters 12/2014; 8(6):2481-2484. · 0.99 Impact Factor