Superficial (early) endocervical adenocarcinoma in situ: a study of 12 cases and comparison to conventional AIS.
ABSTRACT Although established histologic criteria for the diagnosis of endocervical adenocarcinoma in situ (AIS) have been published, some lesions are not readily classified or present with more subtle degrees of epithelial atypia. Lesions confined to the surface mucosa may be particularly challenging, possibly because they represent early disease. Twelve cases of superficial AIS (SAIS) confined to the surface mucosa or crypt openings culled from the in-house and consultation practices were examined histologically, immunostained for MIB-1 and p16, and analyzed (when possible) for HPV nucleic acids by DNA-DNA in situ hybridization (INFORM). The mean age was 26.7 years for SAIS versus 37.0 years for 42 consecutive cases of conventional AIS from the same practice (P < 0.001). Seven and five were biopsies and conization specimens, respectively. Five coexisted with CIN, four arose in endocervical papillae, and two arose in endocervical polyps. Nuclear hyperchromasia was conspicuous in 10 and mitoses were present in all; however, apoptosis was rare or absent in four, and six exhibited only mild nuclear atypia. Mib-1 staining exceeded 40% in 5 of 7 cases tested, and all (8 of 8) were strongly positive for p16(ink4). Five of five were positive for HPV by ISH with an "integrated" dot-like pattern. SAIS is an early variant of AIS that 1) occurs at a younger mean age, 2) exhibits variable atypia, and 3) arises adjacent to morphologically normal columnar epithelium. Diffuse p16 expression and integrated HPV pattern are identical to that seen in more extensive forms of the disease. Superficial AIS should be suspected in endocervical columnar epithelium with segmental nuclear hyperchromasia with mitotic activity, and confirmed by biomarker staining (p16 and Mib-1) if the pathologist is uncertain of the diagnosis.
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ABSTRACT: RESUMEN Entre las lesiones que se encuentran en el endocérvix hay un grupo de alteraciones benignas con características morfológicas estructu-rales y celulares muy similares a las neoplasias (adenocarcinomas). En este trabajo se revisan las lesiones que simulan neoplasias, la displasia endocervical y el adenocarcinoma in situ, con la intención de ayudar en su diagnóstico diferencial y de mostrar las direcciones que la investigación del tema ha tomado. Palabras clave: lesiones que simulan neoplasias, "displasia endocervical", adenocarcinomas, adenocarcinoma in situ. ABSTRACT Amongst endocervical lesions there is a benign group with morphological (architectural and cellular) similarities with neoplasia (adenocar-cinoma). To help in its differential diagnosis and to show the course followed by this topic research, here we review neoplasia-like lesions, endocervical dysplasia and in situ adenocarcinoma. Key words: Neoplasia-like lesions, endocervical dysplasia, adenocarcinoma, in situ adenocarcinoma.
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ABSTRACT: Context.-Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings. Objective.-To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix. Conclusions.-Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.Archives of pathology & laboratory medicine 04/2014; 138(4):453-83. DOI:10.5858/arpa.2012-0493-RA · 2.88 Impact Factor