Superficial (early) endocervical adenocarcinoma in situ: A study of 12 cases and comparison to conventional AIS
Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. American Journal of Surgical Pathology
(Impact Factor: 5.15).
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: The classification of cervical precancers has evolved over the past 40 years as knowledge concerning the pathogenesis of these human papillomavirus-related lesions has expanded. This commentary reviews the current classification scheme in light of (1) the historical classification systems and (2) the ability of the target epithelium, that is the transformation zone to exhibit varied morphology depending on the cell type that is infected with human papillomavirus. The evolution in our understanding of preinvasive glandular neoplasia is also summarized, with particular attention to so-called superficial (or early) adenocarcinoma in situ. In addition, practical issues in the diagnosis and management of squamous epithelial lesions, particularly the recognition of nonconventional variants and the application of biomarkers, are discussed.
Available from: Máire A Duggan
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