Studies on the histology and carbohydrate histochemistry of adenocarcinomas of the cervix uteri

Abstract

A total of 1,999 cases of primary malignancy of the uterine cervix were diagnosed histologically over a 20 yr. period from 1950 to 1969 at the Institute of Pathology, Singapore. This figure represents virtually all the histologically diagnosed cervical cancers (biopsy and necropsy) from the Singapore population. The cervical cancers were composed of 1,896 cases of squamous cell carcinoma, 4 cases of leiomyosarcoma, 1 case of sarcoma botryoides and 98 cases (4.9%) of adenocarcinomas. Cases of carcinoma in situ were excluded from this study. The paper was based on a pathological analysis of the 98 cases of cervical adenocarcinomas, which constituted an exceptionally large series of this neoplasm. The vast majority of the tumours (79 cases or 80.6%) occurred in the fourth, fifth and sixth decades, with a peak frequency in the fifth (32 cases or 32.7%). There were no significant differences in the relative frequencies of the neoplasm among the various races in Singapore. The following histological patterns were encountered among the glandular carcinomas. I. Adenocarcinomas (86 cases) comprising the following subtypes: papillary, adeniform, trabecular, mucoid, medullary, anaplastic, and mixed. II. Combined glandular and squamous carcinomas (10 cases) comprising mixed (collision) and adenosquamous (blended) subtypes. III. 'Mesometanephric' carcinoma (1 case). IV. Adenoidal basal carcinoma (1 case). The tumours were graded as follows. Grade I: well differentiated; Grade II: moderately differentiated; and Grade III: poorly differentiated. The vast majority of cancers (91 cases or 92.9%) belonged to Grades II and III. The tumours generally produced abundant mucosubstances. The secretions consisted of neutral mucins and acidic mucins. The acidic moiety was made up of sulphomucins and sialomucins. The sialomucins were generally sensitive to neuraminidase digestion, unlike those of the normal postmenopausal cervix. Except for a few poorly differentiated tumours which produced little mucosubstances, the amount and type of secretion did not bear a significant relationship to the degree of differentiation or the histological type of tumour. Glycogen formation was generally not observed in these tumours.