Minimal Deviation Adenocarcinoma Research Articles

Intranuclear cytoplasmic inclusion is a significant diagnostic feature for the differentiation of lobular endocervical glandular hyperplasia from minimal deviation adenocarcinoma of the cervix

Lobular endocervical glandular hyperplasia (LEGH) is a cervical lesion with pyloric gland metaplasia. Minimal deviation adenocarcinoma (MDA) is an extremely well differentiated form of endocervical adenocarcinoma (AC). To date, it is difficult to differentiate LEGH from MDA because they share similar clinical, radiological, and immunohistochemical features. Furthermore, the cytological features of LEGH and MDA have not been well defined. In the present study, we describe the cytological features of LEGH and MDA. We reviewed 24 cases of LEGH (18 pure and six mixed forms) and four MDA cases of the cervix. A total of 40 cytologic smears from 28 patients were reviewed. Abundant yellow mucin was frequently present in both LEGH and MDA; however, an INCI was found in 22 of the 24 LEGH cases and it was not found in either MDA or adenocarcinoma cells associated with LEGH. Neither cell atypia nor architectural distortion was observed in LEGH. In MDA, slight cellular atypia, three dimensional, irregular cell clustering, and prominent nucleoli were observed. The presence of an INCI is a good parameter for the diagnosis of LEGH. Cytology is an effective aid in the differentiation of LEGH from MDA.

Expression of protein in cervical minimal deviation adenocarcinoma

Objective To study the valuable index for the diagnosis of cervical minimal deviation adenocarcinoma(MDA).Methods Immunohistochemical EnVisionTM two-step method was used to evaluate the expression of CEA,Ki-67,p16,MUC6,MUC5AC,ER,PR,α-SMA in 9 samples of MDA.12 normal cervical gland tissues and 21 other types of cervical adenocarcinomas were as controls. Results The expression of CEA,MUC6,α-SMA protein in MDA(positive ratio orderly 66.67%,77.78%,88.89%)was higher than that of normal cervical gland(0,8.33%).The average Ki-67 labeling index in MDA(21.03±5.46)was also higher than that of the normal group(0.12±0.08).But as to the expression of ER and PR,the former was lower than the latter.All the differences had statistical significance (P<0.05).The expression of p16,MUC5AC had no statistical significance between the two groups(P＞0.1).The ratio of positive expression of MUC6 protein in MDA(77.78%)was higher than that of the other types of adenocarcinomas(14.29%),with the expression of p16(11.11%)lower than the latter(71.43%).All the differences had statistical significance(P＜0.01).The expression of CEA,Ki-67,MUC5AC,ER,PR,α-SMA had no statistical significance between the two groups(P＞0.05).Conclusion Immunohistochemical positive detection of CEA,Ki-67,MUC6,α-SMA perhaps make for the diagnosis of cervical MDA.The absence of ER,PR of gland cells also support MDA.Overexpression of p16 may play an impo~ant role on the occurrence and the development of some usual adenocarcinoma of cervix,but perhaps not in MDA. Key words: Uterine cervical neoplasms; Adenocarcinoma; Immunohistochemistry

Gastric Morphology and Immunophenotype Predict Poor Outcome in Mucinous Adenocarcinoma of the Uterine Cervix

Endocervical-type mucinous adenocarcinoma (ECA) of the uterine cervix is defined as a tumor composed of cells resembling those of the endocervical glands, but recent studies have demonstrated that a minority of ECAs displays a gastric immunophenotype. The aim of this study was to assess the significance of the gastric phenotype. Fifty-three cases of mucinous adenocarcinoma of the uterine cervix (37 FIGO stage IB, 4 stage IIA, and 12 stage IIB) were reviewed and reevaluated using a newly established morphologic criteria for distinguishing gastric type adenocarcinoma, which was defined as a tumor showing clear and/or pale eosinophilic and voluminous cytoplasm, with distinct cell borders. The results were correlated with gastric immunophenotype, determined by HIK1083 and MUC6 immunostaining, and patient outcome. Following the current World Health Organization scheme (2003), 47 tumors (89%) were classified as ECA, 1 (2%) as intestinal type, 1 (2%) as mixed endocervical and intestinal type, and 4 (8%) as minimal deviation adenocarcinoma. Twelve of 47 (26%) ECAs and all 4 minimal deviation adenocarcinomas, reclassified as gastric type using the novel criteria, were frequently positive for HIK1083 with a rate of 75% (12/16), whereas only 11% (4/37) of nongastric tumors were positive. There was no significant difference in MUC6 reactivity between gastric and nongastric type tumors (31%, 5/16 vs. 16%, 6/37; P=0.4). Patients with gastric-type adenocarcinomas had a significantly decreased 5-year disease-specific survival rate (30 vs. 77%; P<0.0001), and the gastric type morphology was related to a significant risk for disease recurrence compared with the nongastric type (P=0.001; HR, 4.5; 95% confidence interval, 1.42-14.2). HIK1083-positivity was also related to decreased 5-year disease-specific survival rate (38% vs. 74%; P<0.005). Mucinous adenocarcinoma of the uterine cervix with gastric immunophenotype can be a distinct morphologic variant showing an aggressive clinical course.

Immunohistochemistry as a diagnostic aid in cervical pathology

As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.

Histopathological challenges in assessing invasion in squamous, glandular neoplasia of the cervix

Summary Cervical carcinomas usually arise from dysplastic epithelium. Squamous cell carcinoma, the most common type, evolves from cervical intraepithelial neoplasia (CIN) while adenocarcinoma develops from cervical glandular intraepithelial neoplasia (CGIN). The diagnosis of frankly invasive disease does not create a diagnostic problem. In contrast, confident diagnosis of the earliest stage of invasive disease arising from a dysplastic precursor lesion is problematic. The diagnostic process is further complicated by a lack of concordance concerning the nature (and behaviour) of certain diseases associated with the cervix e.g. CIN3-like squamous carcinoma, papillary squamo-transitional cell carcinoma, minimal deviation adenocarcinoma, adenoid basal carcinoma and microcystic adenocarcinoma. In this mini-symposium, an attempt has been made to clarify the features that are suggestive of definitive stromal invasion and to highlight the features of those unusual carcinomas that are often misinterpreted as non-invasive disease.

Association d'un adénocarcinome du col de type endométrioïde à un cystadénocarcinome mucineux de l'ovaire

The authors report the case of a 40-year-old woman, who was operated for an ovarian mucinous cystadenocarcinoma. The pathologic findings of the hysterectomy specimen with bilateral salpingoophorectomy showed an ovarian mucinous cystadenocarcinoma associated with an endometrioid adenocarcinoma of the uterine cervix. The mucinous cystadenocarcinoma represents the third most common type of ovarian carcinoma. In the literature, this tumor had been found in association with endocervical adenocarcinoma or with minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix. However, its association with an endometrioid adenocarcinoma, to our knowledge, has not been reported.

Peutz-Jeghers Syndrome with Multiple Genital Tract Tumors and Breast Cancer: A Case Report with a Review of Literatures

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.

Recent Developments and Selected Diagnostic Problems in Carcinomas of the Endometrium

Two major types of endometrial carcinoma have been well described as differing not only in their pathogenesis but also in their behavior, therefore requiring different management. These implications make the differential diagnosis between the 2 pathogenetic types, specifically their prototypes, endometrioid and serous endometrial carcinomas, paramount. However, this differential diagnosis may be difficult owing to overlapping histologic features such as papillary architecture. To that end, the differential diagnosis of endometrial tumors with papillary morphologic features is discussed in detail. Preinvasive and early invasive serous carcinoma (endometrial intraepithelial carcinoma and minimal serous carcinoma) have been claimed to have a good prognosis if accurate staging confirmed lack of extrauterine spread. Definitions and diagnostic features of these small serous lesions are described. In addition, several recently described variants and histologic patterns of endometrial carcinoma that might present diagnostic problems, such as microglandular mucinous carcinoma, sertoliform carcinoma, carcinoma arising in an atypical polypoid adenomyoma, and endometrial carcinoma with a minimal deviation adenocarcinoma pattern of myoinvasion, are described.

Pseudoinfiltrative Tubal Metaplasia of the Endocervix: A Potential Form of In Utero Diethylstilbestrol Exposure-Related Adenosis Simulating Minimal Deviation Adenocarcinoma

We report three cases of unusual tubal-type endocervical glandular proliferations simulating minimal deviation adenocarcinoma in women with a history of in utero diethylstilbestrol (DES) exposure. The lesions were characterized by haphazard glandular proliferations extending from 3.4 to 6.1 mm into the endocervical stroma and to the margins of excision in all cases. Most of the glands were small to medium-sized and round; some exhibited a moderate degree of cystic dilatation, and occasional glands had curvilinear profiles. The glandular epithelium displayed extensive tubal-type differentiation in all cases. In two cases, the glands lacked cytologic atypia and mitotic activity, and in one case, there was mild to moderate nuclear atypia with occasional mitotic activity. Immunohistochemical studies showed diffuse expression of estrogen and progesterone receptors and essentially no expression of p16 in two cases tested; there was no expression of CD10 in one case that was tested. The Ki-67 proliferation index was zero in one case and 25% in another. Human papillomavirus DNA was not detected by in situ hybridization in one case that was tested. The proliferations lacked features of mucinous and tubo-endometrioid types of minimal deviation adenocarcinoma. The clinicopathologic findings suggest the lesions are benign, and the association with in utero DES exposure raises the possibility that these could be a form of DES-related adenosis.

Absence of Human Papillomavirus Infection in Minimal Deviation Adenocarcinoma and Lobular Endocervical Glandular Hyperplasia

The human papillomavirus (HPV) is basically always detected in squamous cell carcinoma of the cervix and its precursors; a high incidence of HPV also has been reported in adenocarcinoma and adenocarcinoma in situ of the uterine cervix. Lobular endocervical glandular hyperplasia (LEGH) was first described by Nucci in 1999. It is difficult to differentiate minimal deviation adenocarcinoma (MDA) from LEGH preoperatively or postoperatively by clinical and pathologic features. The relationships between HPV and MDA or LEGH have not been studied well because of the rare incidence of the two diseases. To our knowledge, the HPV status in LEGH has not been reported. This study was designed to investigate HPV infection in MDA and LEGH, using the polymerase chain reaction (PCR) technique. Tumor tissue lesions were microdissected and the detection of HPV and its typing were analyzed by PCR-based assay. As the control, HPV DNA was detected in all cases of squamous cell carcinoma and three of five cases of adenocarcinoma. However, no HPV DNA was detected in any of the 10 cases of LEGH or in the 3 cases of MDA. These results suggest that MDA and LEGH are probably not related to HPV infection.

Histopathologie des Plattenepithelkarzinoms und des Adenokarzinoms der Cervix uteri

The introduction of a screening programme for carcinoma of the cervix uteri has lead to a reduction in the number of invasive carcinomas and to a relative increase in the frequency of preinvasive cervical lesions. The most frequent type of invasive cancer of the cervix is squamous cell carcinoma. Adenocarcinomas are much more infrequent. Special subtypes of squamous cell carcinomas are the papillary (squamotransitional) subtype, the verrrucous subtype and the lymphoepithelioma-like subtype. Among the various forms of adenocarcinoma, the mucinous subtype is the most frequent, either as endocervical or interstinal subtype. Much more rare are the serous and clear cell carcinomas. Great concern in daily diagnosis causes the adenoma malignum (minimal deviation adenocarcinoma), since this type of adenocarcinoma demonstrates only minor cytological atypia and greatly resembles the different types of endocervical glandular hyperplasia.A report on a cervical carcinoma should always include the typing and grading of the tumor. Immunohistochemical stains are often useful to distinguish the various types of primary cervical cancer and to distinguish these from metastatic lesions.

Reproducible and clinically meaningful differential diagnosis is possible between lobular endocervical glandular hyperplasia and ‘adenoma malignum’ based on common histopathological criteria

The aim of the present study was to determine if the differential diagnosis between lobular endocervical glandular hyperplasia (LEGH) and minimal deviation adenocarcinoma (MDA), or 'adenoma malignum', is reproducible when clear criteria for these two lesions are given. A total of 44 proliferative endocervical glandular lesions were collected, for which differential diagnosis from MDA was considered to be necessary. Seven observers independently classified these 44 lesions into LEGH, LEGH with adenocarcinoma in situ (AIS), MDA, or common cervical adenocarcinoma, according to the following criteria: LEGH was non-invasive proliferation of endocervical glandular cells without any obvious adenocarcinoma component. MDA was very well-differentiated endocervical-type mucinous adenocarcinoma composed mostly of LEGH-looking glands but containing the component of obviously invasive adenocarcinoma. LEGH with AIS was defined as continuous coexistence of LEGH and AIS. Among these four diagnostic categories, the interobserver agreement level was substantial (kappa = 0.618). The level increased to almost perfect (kappa = 0.928) between the group of non-invasive lesions consisting of LEGH and LEGH with AIS and the other group of invasive lesions comprising MDA and common adenocarcinoma. When the modal diagnosis was adopted as the final diagnosis for individual lesions, the 5 year survival rate of patients after surgery was 100% for the non-invasive lesions but only 54% for the invasive lesions (P < 0.01). It is clearly shown that reproducible differential diagnosis is possible between LEGH, LEGH with AIS, and MDA and that such a differentiation is clinically meaningful.

Prevalence of human papillomavirus DNA in various histological subtypes of cervical adenocarcinoma: a population-based study

The role of human papilloma virus (HPV) infection in the development of cervical carcinoma is well established, however, the prevalence of HPV DNA in cervical adenocarcinoma varies from study to study. It appears to be caused by a number of factors, one of which is that cervical adenocarcinomas comprise a heterogeneous group of multiple subtypes. To clarify the impact of HPV infection on the development of cervical adenocarcinoma with diverse histological subtypes, we performed a population-based study in Korean women from 15 different institutes for the status of HPV infection in adenocarcinoma of uterine cervix. A total of 432 cervical adenocarcinomas from 1997 to 2001 were reviewed and classified according to the modified WHO classification. For 135 cases, HPV typing was performed with HPV DNA chip (82 cases) and PCR HPV typing (53 cases), using formalin-fixed, paraffin-embedded archival tissue. The overall prevalence of HPV infection in cervical adenocarcinoma was 90%. The infection of HPV 16 and/or HPV 18 accounted for 78% of HPV-positive adenocarcinomas. Multiple HPV types were found in 13% of the cases. The HPV DNA was rarely detected in minimal deviation adenocarcinoma. Interestingly, HPV 16 was a predominant type in endometrioid and villoglandular types, whereas HPV 16 and HPV 18 were detected with equal prevalence in other subtypes. In conclusion, HPV infection, mostly HPV 16 and HPV 18, is highly associated with most of the cervical adenocarcinomas, whereas endometrioid and villoglandular type have a different pattern of HPV infection status. Minimal deviation adenocarcinoma does not seem to be related with HPV infection.

Immunophenotypic alteration of the stromal component in minimal deviation adenocarcinoma (‘adenoma malignum’) and endocervical glandular hyperplasia: a study using oestrogen receptor and α‐smooth muscle actin double immunostaining

To define the phenotypic alteration of the stromal component in association with destructive invasion which is a crucial feature in distinguishing minimal deviation adenocarcinoma (MDA) from benign endocervical glandular lesions. We studied endocervical glandular hyperplasias including non-specific-type (NEGH) (n = 3) and lobular-type (LEGH) (n = 8), and minimal deviation adenocarcinoma (MDA) (n = 11), well-differentiated endocervical adenocarcinoma of usual-type (WDA) (n = 11), and adenocarcinoma in situ (AIS) (n = 6) of the cervix, by double immunostaining for oestrogen receptor (ER) and alpha-smooth muscle actin (alpha-SMA) using peroxidase- and alkaline phosphatase-polymer methods, respectively. Glands in NEGH invariably showed nuclear staining for ER, with surrounding ER+/alpha-SMA- stromal cells, whereas LEGH also harboured ER+/alpha-SMA- spindle cells, but lacked nuclear staining for ER in constituent glands. In contrast, both WDA and MDA displayed accompanying stroma rich in alpha-SMA+ spindle cells in close vicinity to the infiltrating neoplastic glands, with only occasional weakly ER+ stromal cells. WDA tended to contain more alpha-SMA+ cells. The distribution of alpha-SMA+ cells was periglandular (6/11), patchy (6/11), and/or diffuse (4/11) in WDA, whereas in MDA it was periglandular (11/11) and/or patchy (8/11). AIS was surrounded by ER+/alpha-SMA- stromal cells. All cases of WDA, MDA, and AIS lacked nuclear staining for ER. Both MDA and WDA can be distinguished from LEGH and NEGH by identifying surrounding alpha-SMA+ stromal cells and the absence or decreased number of ER+ cells, possibly as a result of the desmoplastic reaction with myofibroblasts replacing pre-existing ER+ stromal cells. In particular, the periglandular distribution of these alpha-SMA+ stromal cells can be a clue suggesting destructive stromal invasion in cases of MDA, although occasional glands may lack these cells.

Extremely well‐differentiated adenocarcinoma of the gastric cardia: A unique case with columnar cells and laminated stones

Extremely well-differentiated adenocarcinoma (EWDA) is an unusual gastric cancer that is histologically too bland to be diagnosed as malignant neoplasm, particularly using biopsy. EWDA may be a gastric counterpart of 'adenoma malignum' or minimal deviation adenocarcinoma (MDA) in the uterine cervix; however, the clinicopathological features of EWDA remain less apparent than those of MDA. A 60-year-old male was complaining of dysphagia. He had been made aware of a small submucosal tumor in the cardia 2 years before the onset of this symptom. Endoscopic ultrasonographic examination revealed a large cardiac tumor consisting of thickened layers, as observed in Borrmann type IV. Three mucosal biopsies suggested only benign changes including adenoma and hyperplastic polyps. At the fourth biopsy, cytologically bland columnar cells were located in the submucosa along with stromal fibrosis and laminated stones. The possibility that non-neoplastic aberrant pancreas with lithiasis formed the tumor was denied at laparotomy by a frozen section that revealed benign-looking glands invading the diaphragm. Immunohistochemically the cancer glands were positive for CA19-9 and human gastric mucin, but not for p53 or MUC2. To our knowledge, this is a previously unknown combination of EWDA and psammomatous calcification in the stomach.

MRI of endocervical glandular disorders: three cases of a deep nabothian cyst and three cases of a minimal-deviation adenocarcinoma

The incidence of cervical adenocarcinoma is increasing. Nabothian cysts are a common gynecologic condition; if multiple and/or large cysts are present, it is difficult to differentiate them from a minimal-deviation adenocarcinoma (MDA), which is classified as a special type of cervical adenocarcinoma. We report three cases of deep nabothian cysts and three cases of MDAs. Magnetic resonance imaging (MRI) findings, signs, and symptoms of these cases are described. The absence of a watery discharge and an MR image displaying a round or oval cyst without enhancement after intravenous gadolinium are helpful in the diagnosis of a deep nabothian cyst.

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‘

Gastrointestinal phenotype in cervical adenocarcinomas was examined by immunohistochemistry and correlated with morphologic features. Antibody panels included anti-MUC2, MUC6, CD10, chromogranin A (CGA) and HIK1083. In addition, expression of p16INK4, a cyclin-dependent kinase inhibitor which is expressed in a variety of high-risk HPV-related conditions, was studied. A total of 94 invasive adenocarcinomas including 20 minimal deviation adenocarcinomas (MDAs) and 72 adenocarcinomas in situ (AIS) were examined. MDAs were most frequently positive for HIK1083 and/or MUC6, two representative gastric markers, with a rate of 95%, followed by intestinal-type adenocarcinomas (IAs) with a rate of 85% whereas only 27% of 56 usual endocervical-type adenocarcinomas (UEAs) were positive. MUC2, a goblet cell marker, was positive in 85% and 25% of IAs and MDAs, respectively, while in only 14% of UEAs. CD10 was positive in 15% of IAs, indicating incomplete intestinal differentiation without a brush border in most of the cases. CGA-positive cells were frequently seen in MDAs and IAs with rates of 60% and 62%, respectively. Nuclear and cytoplasmic p16INK4 positivity was identified in 93% of UEAs, whereas 30% of MDAs were positive for p16INK4. Results in AISs were comparable to their invasive counterparts, but morphologically usual-type AISs identified in eight cases of MDA were frequently positive for HIK1083 (75%) and MUC6 (63%), and p16INK4. Of note was the existence of lobular endocervical glandular hyperplasia (LEGH) with atypical features including cytologic abnormalities, and/or papillary projection, which were identified in this study in pure form (n=3) or in association with MDAs (n=6), but not in cases of other types of adenocarcinomas. These observations indicate that gastrointestinal phenotype is frequently expressed in MDAs and IAs, and there seems to be a possible link between MDA, and LEGH and morphologically usual-type AIS with gastric immunophenotype in histogenesis. Frequent absence of p16INK4 expression in MDAs suggests a possibility that high-risk HPV does not play a crucial role in development of MDAs, in contrast to the majority of endocervical adenocarcinomas. p16INK4 immunohistochemistry appears to be a promising diagnostic tool, but pathologists should be aware of frequent negative staining in MDAs, which can be a source of erroneous diagnosis.

Recent advances in the diagnosis and classification of endocervical glandular lesions

Non-invasive endocervical glandular lesions span a spectrum from benign (some of which exhibit worrisome architectural or cytological features) through atypical (endocervical gland dysplasia) to malignant (adenocarcinoma in situ). The differential diagnosis of these lesions is discussed, with emphasis on the morphological features, semi-quantitative scoring system, and ancillary techniques. The discussion of invasive adenocarcinomas covers such difficult topics as microinvasive adenocarcinoma, minimal deviation adenocarcinoma, and mesonephric and microcystic adenocarcinomas. Update on the use of ancillary studies in the differential diagnosis of endocervical and endometrial adenocarcinomas is included. Finally, selected benign endocervical glandular lesions that can cause confusion with adenocarcinoma are covered; these include lobular endocervical hyperplasia, diffuse laminar endocervical glandular hyperplasia, mesonephric remnant hyperplasia, deep Nabothian cysts and tunnel clusters.

Pelvic imaging: multicystic uterine cervical lesions. Can magnetic resonance imaging differentiate benignancy from malignancy?

To evaluate whether magnetic resonance imaging (MRI) can be used to differentiate between malignant and benign multicystic uterine cervical lesions. Twenty-two patients with cervical adenocarcinomas, including minimal deviation adenocarcinoma, and five patients with benign multicystic lesions were classified as a percentage of solid components on MRI. Cystic components were further classified by average cyst diameter and signal intensity of the cyst fluid on T1WI. All nine of the entirely solid lesions were malignant. In contrast, two of the entirely cystic lesions were benign. Ten of the ordinary adenocarcinomas had both solid and cystic components. However, three of the 16 solid and cystic lesions were benign. Lesions composed of cysts smaller than 5mm tended to be malignant; however, some lesions composed of larger cysts were also malignant. Three of 5 lesions with low-signal and 7 of 10 with intermediate-signal fluid were malignant. The malignancy potential was higher in the lesions with a higher percentage of solid components. However, determining whether multicystic lesions were benign or malignant based on the existence of solid components, the average cyst size, and the signal intensity of cyst fluid was impossible. Although a multicystic lesion with solid components in the deep cervical stroma had been reported as a MR finding of a minimal deviation adenocarcinoma, this does not appear to be pathognomonic.

Difference in cytoplasmic localization pattern of neutral mucin among lobular endocervical glandular hyperplasia, adenoma malignum, and common adenocarcinoma of the uterine cervix.

To investigate whether the cytoplasmic localization pattern of neutral mucin differs between lobular endocervical glandular hyperplasia (LEGH) and cervical adenocarcinoma (CxAd), including minimal-deviation adenocarcinoma (MDA), or adenoma malignum, alcian blue (pH 2.5)/periodic acid-Schiff (AB-PAS) staining was performed to formalin-fixed paraffin-embedded tissue sections of 13 lesions of LEGH and 53 tumors of CxAd, including 6 tumors of MDA. The cytoplasmic localization of neutral mucin was classified as a "whole cytoplasmic pattern," in which neutral mucin filled the cytoplasm entirely, or as an "apical pattern," in which neutral mucin was localized in the subsurface area only. Cytoplasmic neutral mucin patterns were detected in all 13 cases of LEGH and in 19 cases (36%) of CxAd, including five cases of MDA. The localization of neutral mucin was always the whole cytoplasmic pattern in 13 cases of LEGH, but was the apical pattern in these 19 cases of CxAd. The other 34 cases of CxAd, including 1 case of MDA, corresponded to the acid mucin pattern stained purple or blue or no staining pattern by AB-PAS. Among the 53 cases of CxAd, the apical neutral mucin pattern was an indicator of poorer patient prognosis by univariate and multivariate analyses. The examination of cytoplasmic localization of neutral mucin might be applicable, not only to differential diagnosis between LEGH and CxAd, including MDA, but also to estimate clinical aggressiveness of CxAd.