A retrospective study on incidence, diagnosis, and clinical outcome of gastric-type endocervical adenocarcinoma in a single institution
Tóm tắt
Gastric-type endocervical adenocarcinoma is rare but the most common subtype of cervical adenocarcinoma not associated with human papillomavirus. It is more aggressive with a shorter five-year survival rate compared to human papillomavirus-associated usual type endocervical adenocarcinoma. The objectives of our study were to determine the incidence and clinical-pathological characteristics of Gastric-type endocervical adenocarcinoma in a single institution. Twenty four cases of invasive cervical adenocarcinoma were identified between January 2000 and December 2015, from the Saskatoon Health Region pathology database using International Endocervical Adenocarcinoma Criteria and Classification to retrospectively classify endocervical adenocarcinoma. Immunohistochemistry was performed with antibodies for Gastric mucin-6 (MUC-6), p16INK4a, cyclin-dependent kinase inhibitor 2A (p16), p53 protein (p53), estrogen and progesterone receptors. Clinical and pathological data was retrieved from pathology reports and charts. Statistical analysis was performed using Mann-Whitney U test and Chi-Square test. Using the International Endocervical Adenocarcinoma Criteria and Classification criteria, 19 cases (79.2%) were classified as human papillomavirus-associated usual type endocervical adenocarcinoma, and five cases (20.8%) as Gastric-type endocervical adenocarcinoma. In our study 40% of Gastric-type endocervical adenocarcinoma cases presented at stage III compared to none of the usual type endocervical carcinoma cases. All the Gastric-type endocervical adenocarcinoma cases were positive for MUC-6, and negative for p16. 60% Gastric-type endocervical adenocarcinoma cases demonstrated mutant type p53 staining. In contrast, 84.2% of human papillomavirus-associated usual type endocervical adenocarcinoma cases showed block like nuclear and cytoplasmic positivity with p16 antibodies. The Gastric-type endocervical adenocarcinoma group had significantly shorter median survival time than human papillomavirus-associated usual type endocervical adenocarcinoma group, Gastric-type endocervical adenocarcinoma is 22 months compared to human papillomavirus-associated usual type endocervical adenocarcinoma at 118 months (p = 0.043). In this study, Gastric-type endocervical adenocarcinoma accounted for 20.8% of all cervical adenocarcinoma with higher stage at presentation and shorter overall survival. Criteria proposed by International Endocervical Adenocarcinoma Criteria and Classification (IECC) are simple and reproducible in differentiating between, HPV- associated (HPVA) and non HPV associated (NHPVA) endocervical adenocarcinoma. Although none of the IHC assays is specific for GAS, but p16, MUC-6, ER, PR and p53 may further aid in confirming GAS and to differentiate it from benign and malignant mimics.
Tài liệu tham khảo
Worldwide cancer data [Internet]. World Cancer Research Fund. 2021 [cited 5 March 2021]. Available from: https://www.wcrf.org/dietandcancer/cancer-trends/worldwide-cancer-data.
Smith HO, Tiffany MF, Qualls CR, Key CR. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—a 24-year population-based study. Gynecol Oncol. 2000;78(2):97–105. https://doi.org/10.1006/gyno.2000.5826.
Quint KD, de Koning MN, Geraets DT, et al. Comprehensive analysis of human papillomavirus and trachomatis in in-situ and invasive cervical adenocarcinoma. Gynecol Oncol. 2009;11:390–4.
WHO Classification of tumors Editorial Board. WHO Classification of Tumors: Female Genital Tumors. Lyon, France: IARC; 2020.
Kojima A, Mikami Y, Sudo T, Yamaguchi S, Kusanagi Y, Ito M, et al. Gastric morphology and immunophenotyped predict poor outcome in mucinous adenocarcinoma of the uterine cervix. Am J Surg Pathol. 2007;31(5):664–72. https://doi.org/10.1097/01.pas.0000213434.91868.b0.
Karamurzin YS, Kiyokawa T, Parkash V, Jotwani AR, Patel P, Pike MC, et al. Gastric -type endocervical adenocarcinoma: an aggressive tumor with unususal metastatic patterns and poor prognosis. Am J Surg Pathol. 2015;39(11):1449–57. https://doi.org/10.1097/PAS.0000000000000532.
Nishio S, Mikami Y, Tokunaga H, Yaegashi N, Satoh T, Saito M, et al. Analysis of gastric-type mucinous carcinoma of the uterine cervix - an aggressive tumor with a poor prognosis: a multi-institutional study. Gynecol Oncol. 2019;153(1):13–9. https://doi.org/10.1016/j.ygyno.2019.01.022.
Ronnett BM. Endocervical adenocarcinoma: selected diagnostic challenges. Mod Pathol. 2016;29(S1):S12–28. https://doi.org/10.1038/modpathol.2015.131.
Turashvili G, Morency EG, Kracun M, et al. Morphologic features of gastric-type cervical adenocarcinoma in small surgical and cytology specimens. Int J Gynecol Pathol. 2019;38(3):263–75. https://doi.org/10.1097/PGP.0000000000000519.
Talia KL, W. Glenn McCluggage. The developing spectrum of gastric-type cervical glandular lesions. Pathology. 2018;50(2):122–9. https://doi.org/10.1016/j.pathol.2017.09.009.
Pirog EC, Park KJ, Kiyokawa T, Zhang X, Chen W, Jenkins D, et al. Gastric-type adenocarcinoma of the cervix: tumor with wide range of histologic appearances. Adv Anat Pathol. 2019;26(1):1–12. https://doi.org/10.1097/PAP.0000000000000216.
Stolnicu S, Barsan I, Hoang L, et al. International Endocervical adenocarcinoma criteria and classification (IECC): a new pathogenetic classification for invasive adenocarcinomas of the endocervix am J Surg. Pathol. 2018:214–26.
Stolnicu S, Basran I, Hoang L, et al. Diagnostic algorithmic proposal based on comprehensive immunohistochemical evaluation of 297 invasive endocervical adenocarcinomas. Am J Surg Pathol. 2018;42(8):989–1000. https://doi.org/10.1097/PAS.0000000000001090.
Stolnicu S, Hoang L, Soslow RA. Recent advances in invasive adenocarcinoma of the cervix. Virchows Arch. 2019;475(5):537–49. https://doi.org/10.1007/s00428-019-02601-0.
Stolnicu S, Hoang L, Chiu D, Hanko-Bauer O, Terinte C, Pesci A, et al. Clinical outcomes of HPV-associated and unassociated endocervical adenocarcinomas classified by the international endocervical adenocarcinoma criteria and classification (IECC). Am J Surg Pathol. 2019;43(4):466–74. https://doi.org/10.1097/PAS.0000000000001224.
Hodgson A, Park KJ, Djordjevic B, Howitt BE, Nucci MR, Oliva E, et al. International Endocervical adenocarcinoma criteria and classification: validation and interobserver reproducibility. Am J Surg Pathol. 2019;43(1):75–83. https://doi.org/10.1097/PAS.0000000000001095.
Mikami Y, Kiyokawa T, Hata S, Fujiwara K, Moriya T, Sasano H, et al. Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions: a possible link between lobular endocervical glandular hyperplasia/pyloric gland metaplasia and 'adenoma malignum'. Mod Pathol. 2004;17(8):962–72. https://doi.org/10.1038/modpathol.3800148.
Kusanagi Y, Kojima A, Mikami Y, Kiyokawa T, Sudo T, Yamaguchi S, et al. Absence of high-risk human papillomavirus (HPV) detection in endocervical adenocarcinoma with gastric morphology and phenotype. Am J Pathol. 2010;177(5):2169–75. https://doi.org/10.2353/ajpath.2010.100323.
Carleton C, Hoang L, Shah S, et al. A detailed immunohistochemical analysis of a large series of cervical and vaginal gastric-type adenocarcinomas. Am J Surg Pathol. 2016;40(5):636–44. https://doi.org/10.1097/PAS.0000000000000578.
Lu S, Shen D, Zhao Y, et al. Primary endocervical gastric- type adenocarcinoma: a clinicopathologic and immunohistochemical analysis of 23 cases. Diagn Pathol. 2019;14(72):1–7.
Kojima A, Shimada M, Mikami Y, Nagao S, Takeshima N, Sugiyama T, et al. Chemoresistance of gastric-type mucinous carcinoma of the uterine cervix: a study of the Sankai gynecology study group. Int J Gynecol Cancer. 2018;28(1):99–106. https://doi.org/10.1097/IGC.0000000000001145.
Hodgson A, Parra-Herran C, Mirkovic J. Immunohistochemical expression of HIK1083 and MUC6 in endometrial carcinomas. Histopathology. 2019;75(4):552–8. https://doi.org/10.1111/his.13887.
Nucci MR, Clement PB, Young RH. Lobular endocervical glandular hyperplasia, not otherwise specified: a clinicopathologic analysis of thirteen cases of a distinctive pseudoneoplastic lesion and comparison with fourteen cases of adenoma malignum. Am J Surg Pathol. 1999;23(8):886–91. https://doi.org/10.1097/00000478-199908000-00005.
Mikami Y, Kiyokawa T, Moriya T, Sasano H. Immunophenotypic alteration of the stromal component in minimal deviation adenocarcinoma ('adenoma malignum') and endocervical glandular hyperplasia: a study using oestrogen receptor and alpha-smooth muscle actin double immunostaining. Histopathology. 2005;46(2):130–6. https://doi.org/10.1111/j.1365-2559.2005.02057.x.
Pirog EC. Cervical adenocarcinoma: diagnosis of human papillomavirus-positive and human papillomavirus-negative tumors. Arch Pathol Lab Med. 2017;141(12):1653–67. https://doi.org/10.5858/arpa.2016-0356-RA.
Clement PB, Young RH. Deep nabothian cysts of the uterine cervix. A possible source of confusion with minimal-deviation adenocarcinoma (adenoma malignum). Int J Gynecol Pathol. 1989;8(4):340–8. https://doi.org/10.1097/00004347-198912000-00005.
Jones MA, Young RH, Scully RE. Diffuse laminar endocervical glandular hyperplasia. A benign lesion often confused with adenoma malignum (minimal deviation adenocarcinoma). Am J Surg Pathol. 1991;15(12):1123–9. https://doi.org/10.1097/00000478-199112000-00002.
Nucci MR. Pseudoneoplastic glandular lesions of the uterine cervix: a selective review. Int J Gynecol Pathol. 2014;33(4):330–8. https://doi.org/10.1097/PGP.0000000000000139.
Rabban JT, McAlhany S, Lerwill MF, Grenert JP, Zaloudek CJ. PAX2 distinguishes benign mesonephric and mullerian glandular lesions of the cervix from endocervical adenocarcinoma, including minimal deviation adenocarcinoma. Am J Surg Pathol. 2010;34(2):137–46. https://doi.org/10.1097/PAS.0b013e3181c89c98.