CASE STUDIES 2008
SEARCH
 
 
Fig 1
Fig 1
Fig 2
Fig 2

May 2008
Uterine Cervical Mass in a 29 year old
John W. Bishop, M.D.

Organ: Uterine Cervix
History: A 29 year old woman presented for abnormal vaginal bleeding and was found to have a friable cervical mass. The sample was submitted in formalin, so no cytology was available.
  Gross and Microscopic Features

May 2008
Uterine Cervical Mass in a 29 year old
John W. Bishop, M.D.

Gross and Microscopic Features: The sample consisted of amorphous tan tissue measuring 1.4 x 1.0 x 0.4 cm. At scanning magnification [fig. 1], the tissue consists entirely of delicate papillary tissue with evident fibro-vascular cores and a single-layer epithelial lining. At high magnification [fig. 2], there is evidence of a little architectural complexity with glandular invaginations in the fibrous cores. Inflammatory cells are also seen within the cores. The cytologic features of the malignant epithelium are evident: the cells are generally columnar with sharp but undulating luminal borders. Apocrine-like snouts are present. The cytoplasm is amphophilic without hyaline change or large vacuoles. The nuclear are enlarged, crowded, mildly pleomorphic, and hyperchromatic.
History Differential Diagnosis

May 2008
Uterine Cervical Mass in a 29 year old
John W. Bishop, M.D.

Differential Diagnosis: Lesions with at least superficial resemblance to this one include papillary endocervicitis, papillary adenofibroma, serous papillary adenocarcinoma of cervix, and villoglandular variant of endometrioid carcinoma of endometrium[1]. Papillary endocervicitis and papillary adenofibroma have less cytologic epithelial atypia than this lesion and serous papillary adenocarcinoma has higher grade nuclear abnormalities, a higher mitotic rate, and usually more architectural complexity. Patient age is also helpful, since villoglandular carcinoma of the cervix is found in patients ranging from the 20’s to the early 50’s with a mean of 37 years; while the villoglandular variant of endometrioid carcinoma has the same age range and mean as other endometrioid carcinomas[2]. The diagnosis of villoglandular cervical carcinoma in an older woman must be carefully considered, since metastasis or extension from an endometrial carcinoma is more likely[3]. There may be an association of this lesion with oral contraceptives and high risk HPV[2]. Cytology was not available in this case but the cytological features of villoglandular carcinoma have been described. Notably, histology was required to make the diagnosis in all cases in the published series; the cytology having been called, “atypical glandular cells, of cervical origin.” The cytological features noted retrospectively included large cohesive groups with nuclear crowding, true papillary structures lined by columnar cells with smooth surfaces, and a notable absence of “feathering”, a feature of the intestinal type of adenocarcinoma in-situ which is heavily relied on in screening for glandular lesions[4].
Gross and Microscopic Features Diagnosis

May 2008
Uterine Cervical Mass in a 29 year old
John W. Bishop, M.D.

Diagnosis: Well Differentiated Villoglandular Adenocarcinoma of cervix.
References:
  1. Kurman RJ, ed. Blaustein’s Pathology of the Female Genital Tract 5th ed. 2002 (Springer) P. 360-1; 521-522.
  2. Jones, M.W., S.G. Silverberg, and R.J. Kurman, Well-differentiated villoglandular adenocarcinoma of the uterine cervix: a clinicopathological study of 24 cases. Int J Gynecol Pathol, 1993. 12(1): p. 1-7.
  3. Al-Nafussi, A., et al., Cervical implant from villoglandular endometrial adenocarcinoma masquerading as cervical villoglandular adenocarcinoma. Int J Gynecol Cancer, 2002. 12(3): p. 308-11.
  4. Chang, W.C., et al., Cytologic features of villoglandular adenocarcinoma of the uterine cervix: comparison with typical endocervical adenocarcinoma with a villoglandular component and papillary serous carcinoma. Cancer, 1999. 87(1): p. 5-11.
Differential Diagnosis  
© 2008 Gynecor. All rights reserved. The Tao Brush™ is a registered trademark of Cook® Medical. Privacy Terms