Clinical Pearls & Morning Reports
As compared with squamous-cell carcinomas, cervical adenocarcinomas have been thought to be rare tumors, but the incidence has increased steadily over the past 20 years. Read the latest Case Record of the Massachusetts General Hospital.
Q. What are the treatment options for early-stage cervical carcinoma?
A. Randomized trials have shown equivalent outcomes for radical surgery and pelvic radiation therapy among patients with early-stage (FIGO [International Federation of Gynecology and Obstetrics] stage IB or IIA) cervical carcinoma. The choice of treatment depends on clinical factors, such as age, general health, and cervical-tumor diameter; the goal is to avoid combined surgery and radiation, which is associated with increased adverse effects. Depending on the desire for future fertility, either radical trachelectomy (removal of the cervix) or hysterectomy can be performed in combination with bilateral pelvic lymphadenectomy; the two procedures are associated with similar cure rates.
Q. What are some of the features of endocervical adenocarcinoma?
A. Endocervical adenocarcinoma represents up to 25% of cervical carcinomas that occur in developed countries. Adenocarcinoma (usual type) is the most common glandular neoplasm in the cervix; it is typically well differentiated or, more frequently, moderately differentiated. When adenocarcinoma occurs concurrently with squamous-cell carcinoma, it is characteristically associated with high-risk human papillomavirus (HPV) infection (most frequently types 16, 18, and 45).
A: The 5-year survival rate among patients with invasive cervical adenocarcinoma is similar to the rate among patients with squamous-cell carcinoma, stage for stage; the rate is 100% among those with FIGO stage IA1 tumors, approximately 80% among those with clinically visible lesions, approximately 50% among those with stage II tumors, and approximately 30% among those with stage III tumors.
A: The tumor cells often have cuboidal-to-tall cytoplasm and pseudostratified hyperchromatic nuclei, are depleted of mucin, and have brisk mitotic activity; characteristic histologic features include “hanging” (apical) mitoses and basal apoptotic bodies. The tumor cells can have a variety of architectural patterns, but papillary and cribriform growths are most common. In high-grade squamous dysplasia, as well as in situ and invasive squamous-cell and glandular carcinomas related to high-risk HPV, there is overexpression of the tumor suppressor protein p16INK4A, and p16INK4A is used as a surrogate immunohistochemical marker for the diagnosis of these lesions not only in the cervix but also in other locations, especially the gynecologic tract and the head and neck.