Mixed Adenosquamous Carcinoma Research Articles

Occurrence and Prognosis of Mixed Subtype Adenocarcinoma and Adeno-Squamous Carcinoma in Esophageal Cancer.

Purpose: To gain a deeper understanding of the incidence and survival rates of rare esophageal mixed adenoacanthoma (EAM) and esophageal mixed adeno-squamous carcinoma (EASC) to promote a more comprehensive understanding of these two subtypes. Background: EAM and EASC are rare subtypes of esophageal cancer with limited literature available. Extensive research has been conducted on the clinical and pathological characteristics of gastric and colorectal mixed adenoacanthomas, but there is relatively little literature on esophageal mixed adenoacanthomas. Therefore, this study aims to investigate the incidence and survival rates of these two subtypes in depth. Methods: Patients diagnosed with EAM and EASC between 2000 and 2019 were selected from the SEER database for the study. Joinpoint software was used to calculate the incidence rates of esophageal AM and ASC patients, and differences in cancer overall survival (OS) and cancer-specific survival (CSS) based on Kaplan-Meier curves were compared. Multivariate Cox regression analysis was employed to identify independent prognostic factors for OS and CSS, and a prognostic model was established and validated for accuracy. Results: The study found that the incidence of EAM increased until 2014, followed by a decline, while the incidence of EASC decreased until 2017, followed by an increase. Both of these subtypes were more common in male patients and those over the age of 65. For EAM patients, preoperative chemoradiotherapy was associated with better survival rates, while for EASC patients, preoperative radiotherapy combined with adjuvant chemotherapy improved survival. Finally, we constructed nomograms for predicting the overall survival of EAM and EASC patients by incorporating identified risk factors, which demonstrated good sensitivity and specificity. Conclusion: EAM and EASC are rare subtypes of esophageal cancer, and an in-depth exploration of their incidence and survival rates provides valuable data and insights for understanding these rare esophageal cancer subtypes. This information can assist clinical decision-making for healthcare professionals.

The Multi-slice Spiral Computed Tomography (MSCT) Features of Thin-Walled Cystic Lung Cancer with Ground Glass Opacity

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Thin-walled cystic lung cancer with ground glas s opacity (GGO) is a type of lung carcinoma with specific computed tomography (CT) features. Objectives: To investigate the imaging features of multi-slice spiral computed tomography (MSCT) of GGO and to improve the imaging diagnosis of this type of lung cancer. Patients and Methods: The clinical data of 24 patients with pathologically confirmed thin-walled cystic lung cancer with GGO were retrospectively analyzed in this study. The imaging features of preoperative MSCT, including vascular convergence, burr signs, pleural depression signs, lobulation signs, thickness and uniformity of the cavity wall, partitive membranes, and position of the ground-glass cavity, were examined. The relationship between the imaging features and postoperative pathological findings of lung carcinoma were also explored. Results: Most of the lesions (75.0%) were located in the upper lobe of the lungs. The size range of the cavity was 5.8 - 28.1 mm, with a mean of 13.6 ± 7.2 mm. Fifteen patients (62.5%) had a cavity wall thickness < 2 mm, 6 (25.0%) patients had a cavity wall thickness in the range of 2 - 3 mm, and 3 (12.5%) patients had a cavity wall thickness of about 3 - 4 mm. A uniform cavity wall was found in 10 (41.7%) cases, while a non-uniform cavity wall was observed in 14 (58.3%) cases. Eleven patients showed pure GGO (45.8%), while 13 patients showed mixed GGO (54.2%). Besides, nine patients (37.5%) showed lobular signs, 12 (50.0%) patients showed spicule signs, and 6 (28.6%) patients showed vascular convergence signs. Twelve patients (50.0%) had signs of pleural indentation, while 14 (66.7%) patients showed thick or thin small blood vessel opacity or fine partitive membranes. Twenty-three patients were diagnosed with lung adenocarcinoma, while one patients was diagnosed with mixed adenosquamous carcinoma. Conclusion: Thin-walled cystic lung cancer with GGO is a rare clinical phenomenon. The imaging features of this type of lung cancer on MSCT are consistent with the characteristics of lung cancers.

The Performance of a New Scoring System for Colposcopy in Detecting High-Grade Dysplasia in the Uterine Cervix

This article describes the development of a simple scoring system for colposcopic grading of high-grade cervical dysplasia. Two different clinic populations with a 48% and a 35% rate of high-risk lesions were used to develop the model, which was based on data accumulated from March 2001 to June 2003 during colposcopic examination of women referred for abnormal cytology. Colposcopically directed biopsies were taken of all suspicious areas using punch biopsy, laser cone, or large loop excision of the transformations zone (LLETZ). Only patients with histopathology of the cervix were included in the study (n = 297). All colposcopic examinations were graded by experienced colposcopists for acetowhiteness of the epithelium, lesion margin and surface contour, vessel pattern, lesion size, and iodine staining. A three-point scoring system was used for each colposcopic characteristic (see Table 1).TABLE 1: Scoring modelBenign conditions were seen in 30% of the histopathologic samples, and koilocytosis or cervical intraepithelial neoplasia (CIN 1) was diagnosed in 25%. Forty-four percent of the samples contained high-grade lesions, including cervical intraepithelial neoplasia (CIN) 2 (13%), CIN 3 (28%), and invasive cancer (3%). Using the biopsy diagnosis of high-grade CIN (defined as CIN 2 or greater) as a standard, an “ideal” grading system was constructed that assigned each colposcopic characteristic a weighted value that would produce the best sensitivity and specificity performance for the model. These values were then rounded off to simplify the final grading system shown in Table 1. When the colposcopic lesion characteristics were analyzed by multiple logistic regression, acetowhiteness had the highest correlation to high-grade dysplasia, followed by lesion margin and surface contour, lesion size, iodine staining, and vessel pattern. The distribution of total colposcopic scores for each lesion was then analyzed for the sensitivity and specificity to predict a CIN 2 lesion or greater. No patient with CIN 2 had a colposcopic score of four or less. Only two patients had a score of five. Ninety-five percent of the patients with CIN 2 or greater had a colposcopic score of six or higher. Only 10% of women with CIN 1 or less had a colposcopic score of eight or more. Four women in the series had glandular dysplasia and received scores of eight to 10. All had adenocarcinoma in situ on final histologic evaluation. There were 10 invasive cancers diagnosed. Five women had squamous cell carcinoma, four had adenocarcinoma, and one had a mixed adenosquamous carcinoma. The colposcopic scoring index graded one of these patients with seven points; the other nine received scores of eight to 10. As a control, another 199 women patients were diagnosed with benign, low-grade, or high-grade cervical dysplasia based on the general colposcopic impression of the experienced examiner without using any formal grading system. Eighteen of 85 biopsy-proven high-grade lesions were underdiagnosed by colposcopic impression and six of 114 low-grade lesions were misidentified as high-grade (sensitivity = 79% and specificity = 95%).

Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study.

Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition. The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy. The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined. Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.

The problem of replacement and differentiation of the intestinal epithelium: its relation to squamous metaplasia in the uterine cervix.

The problem of replacement and differentiation of the intestinal epithelium: its relation to squamous metaplasia in the uterine cervix.

Expression of transforming growth factor-alpha in the normal cervix and in benign and malignant lesions of the uterine cervix.

To investigate the expression and distribution of transforming growth factor-alpha (TGF-alpha) in the normal cervix and in benign and malignant lesions of the uterine cervix. Immuno-histochemical reactivity with a monoclonal antibody against TGF-alpha was examined in tissue specimens from 15 normal cervices, six cervical polyps, four cervical condylomata acuminata, 34 cervical intra-epithelial neoplasias, 35 invasive squamous cell carcinomas, five adenocarcinomas, and three mixed adenosquamous carcinomas. Normal squamous cells of the exocervix were found to be negative for TGF-alpha immunoreactivity, whereas reserve cells and metaplastic squamous cells in the transformation zone were positive for TGF-alpha. Although TGF-alpha immuno-reactivity was variable in the cervical condylomas, most cases of cervical intra-epithelial neoplasia with or without koilocytotic atypia were negative for TGF-alpha. In the invasive carcinomas, however, TGF-alpha immuno-reactivity was observed in 17 out of the 35 cases of squamous carcinoma, and in all cases of adeno- and adenosquamous carcinomas. In addition, intense TGF-alpha immuno-reactivity was found in clinically advanced tumours. These results suggest that the expression of TGF-alpha is associated with squamous metaplasia in the normal cervix, and that TGF-alpha may play an important role in cervical carcinogenesis, especially in its progression.

Adenosquamous carcinoma of the prostate: A case report

Mixed types of carcinoma of the prostate are rare. The majority of those described (22 cases) are examples of mixed adenocarcinoma and transitional cell carcinoma. Much more unusual is the mixed adenosquamous carcinoma, of which only three cases have been described. This report presents an additional case of the rare adenosquamous carcinoma of the prostate. It discusses the clinicopathologic features and the possible histogenesis of this tumor and suggests a role for stilbestrol in its development.

Adenocarcinoma-in-situ of the cervix and related lesions

Cases of Adenocarcinoma-in-situ (ATS), micro and frank invasive adenocarcinoma of the cervix from the files of the 1CPMR were studied. The histological type of AIS is best described in terms of the corresponding invasive lesion, i.e. as endocervical AIS, endometrioid AIS, intestinal AIS, papillary serous AIS, clear cell AIS. It may also be described in terms of the nuclear differentiation as well differentiated or poorly differentiated AIS. Mixed adenosquamous carcinomas may be associated with either AIS or CIN 3, or both together. Sometimes a combined adenosquamous-in-situ lesion may be seen. Some adenosquamous carcinomas may be the result of multifocal collisions between adeno and squamous cell carcinomas. Adenosquamous carcinomas feature prominently amongst short survival stage Ib cervical carcinomas. Wart virus effects in neighbouring squamous epithelium were observed in 44.4% of cases of AIS. HPV types 16 and 18 have been demonstrated in invasive and in-situ adenocarcinoma of the cervix but so far there have been no reports of HPV DNA being demonstrable in lesser abnormalities than AIS. Areas of difficulty in histological diagnosis are: 1) Endocervical glandular dysplasia; 2) ‘Microinvasive' adenocarcinoma; and 3) Benign epithelia of similar appearance. There is evidence that the behaviour of a small focus of invasive adenocarcinoma may be worse than that of a similar sized focus of squamous cell carcinoma. This may be due to underdiagnosis of invasion on the criteria currently available.

Thymic Carcinomas

Thirteen cases of primary thymic carcinomas are described. The patients' ages ranged from 19 to 64 years, with a median of 40 years. Nine of them were male. Chest pain with or without cough was the main presenting symptom. No patient had myasthenia gravis. Five histological types were identified; two were undifferentiated (lymphoepithelioma-like) carcinoma, one was a clear-cell carcinoma, two were mixed squamous and small-cell carcinoma, and six were squamous cell carcinoma. All the tumors were variably positive for anti-keratin antibody AE1 and AE3, but negative for AE2. Anti-neuron specific enolase antibody was useful in identifying and confirming the small-cell carcinoma component of the mixed carcinomas. Anti-epithelial membrane antigen antibody aided in revealing the glandular structures in mixed adenosquamous and small-cell carcinomas. Thymic carcinomas were histopathologically differentiated from thymomas by their malignant cytological appearance, increased mitotic activity, and central tumor necrosis. All six patients with pure squamous-cell carcinoma were still alive, with a median survival time of 27 months. All but one of the other patients of different histological types died, the exception being a recent case of mixed adenosquamous and small-cell carcinoma; their median survival was 19.5 months, or 18 months when the latter surviving case is included. The prognosis of patients with pure squamous-cell carcinoma was better.

Neuroendocrine differentiation antigen on human lung carcinoma and kulchitski cells

In the normal lung, a subset of cells with a histological appearance consistent with that of Kulchitski cells are the only lung cells reacting with a monoclonal antibody (MOC-1) raised against a human small cell lung carcinoma-derived cell line. Outside the lung, a subset of normal endocrine cells (in the adrenal, thyroid, ovary, and pancreas) as well as neural cells (brain and peripheral Schwann cells) also express the antigen detected by MOC-1 (named MOC-1-related antigen). Some of these positively reacting cells are ectodermally derived, whereas others are of proven endodermal origin, indicating that the MOC-1-related antigen is not a cell lineage-specific antigen. Instead, the common expression of the antigen by cells with a neural, endocrine, or neuroendocrine function suggests that the antigen related to a neuroendocrine differentiation state of these cells. The presence of the MOC-1-related antigen on several non-lung tumors mostly paralleled its normal tissue distribution, indicating that the antigen is generally retained upon malignant transformation. In lung carcinoma, the antigen proves to be present on almost all small cell carcinomas tested. In addition, adenocarcinoma and mixed adenosquamous carcinoma could also express the antigen, whereas pure squamous cell carcinoma generally did not. This finding will be discussed in relation to a proposed "common stem cell" histogenesis of lung carcinoma.

8 - New Aspects of Endometrial Carcinoma

We have presented a review of aspects of endometrial carcinoma that have received prominent attention since the last review of this subject published in these pages in 1976. These include the relationship of exogenous oestrogens to the development of endometrial cancer; the differential diagnosis of carcinoma from endometrial metaplasias and hyperplasias; the prognostic and therapeutic significance of various histological patterns of carcinoma, including adenoacanthoma, mixed adenosquamous carcinoma, and papillary serous carcinoma; pathological and clinical distinctions between 'true' myometrial, cervical and ovarian invasion and histological findings which mimic these patterns but do not have the same unfavourable prognostic significance; and the prognostic significance of partially or completely host-related factors such as immunological response, hormone receptors, and both exogenous and endogenous hyperoestrinism. Many of the questions posed here remain at least partially unresolved, and it is hoped that further studies will be performed in these areas.

Glassy Cell Carcinoma of the Uterine Cervix

Two cases of glassy cell carcinoma which is considered to be a poorly differentiated mixed adenosquamous cell carcinoma in the uterine cervix are described. Its cytologic and histologic findings are distinctive. The tumor cells had moderately amount and ground-glass cytoplasms, and had large nuclei containing a prominent nucleoli.

Carcinoma of the endometrium. IV. Mixed adenosquamous carcinoma. A clinical-pathological study of 68 cases with long-term follow-up.

In a histologic review of 989 cases of invasive endometrial carcinomas there were 68 mixed adenosquamous carcinomas. Sixty were followed for at least five years, or until death. The other eight were diagnosed in 1976 and were ineligible for five-year status evaluation. Twenty-eight of the 60 patients or 46.7% were alive at five years. Twenty-five or 41.7% died of their cancer. Stage of disease, depth of myometrial invasion, vascular invasion, age, and method of treatment all had an impact on end results. By comparison, the absolute five-year survival rate for 200 women with adenocanthoma was 87.0%. Thirty patients with atypia of the squamous portion of the adenoacanthoma had an identical survival rate as those without atypia. Combined irradiation and hysterectomy end results were superior to hysterectomy only, or to radiation therapy only. Although one examination of time trends revealed a significant increase in the percentage of all tumors that were diagnosed as adenoacanthoma, there was no increase in the relative frequency of mixed adenosquamous carcinoma.

Carcinoma of the endometrium. II. Papillary adenocarcinoma: a clinical pathological study, 46 cases.

Forty-six patients with papillary carcinoma of the endometrium were studied. Forty-five were followed for at least five years or until death, and 41 were followed for 10 years. The remaining patient was alive at four years. The survival rate was 51.1% at five years and 46.3% at 10 years. At five years one-third had died of their disease. The median age at time of diagnosis was 63 years, and the age at diagnosis was an important determinant of survival. None of the seven black women survived for five years. Tumor grade was an important predictor of the course of disease and nuclear grading was a significantly more accurate indicator than was the histologic grading of the World Health Organization. Papillary carcinoma should be distinguished from the papillary type of clear cell carcinoma of the endometrium. While it has a somewhat better prognosis than mixed adenosquamous carcinoma or clear cell carcinoma, it appears to be more aggressive with a lower survival rate and higher rate of death from disease than the usual type of endometrial adenocarcinoma or adenoacanthoma.

Glassy cell carcinoma of the the endometrium

A variant of mixed adenosquamous carcinoma of the endometrium was encountered in 5 of 68 patients (7.4 per cent) with mixed adenosquamous carcinomas of the endometrium. A sixty patient had an isolated area of glassy cell carcinoma in an otherwise typical adenosquamous carcinoma. The ground-glass appearance of the cytoplasm, the distinctive nucleus with prominent nucleoli, the numerous mitoses, and the similarity of this tumor to previously described glassy cell cervix cancers all suggest that the tumor is glassy cell carcinoma. Four of the five tumors behaved in an aggressive manner.

Unstable Cellular Differentiation in Adenosquamous Cell Carcinoma<xref ref-type="fn" rid="FN2">2</xref><xref ref-type="fn" rid="FN3">3</xref>

For the determination of whether two or more stem lines with fixed of stable differentiation are present in a growing mixed adenosquamous cell carcinoma, two different mixed tumors, derived from transformed F344 rat tracheal epithelium, were dissociated and ten single cells were isolated from each tumor. Each of these single cells was allowed to grow 27 population doublings to form a clonal population. All clones were then inoculated into animals for the assessment of in vivo differentiation. All cell inocula produced carcinomas within 7-70 days. Of the ten single cell clones isolated from the first tumor, seven clones produced mixed adenosquamous carcinomas and three produced adenocarcinomas in which no squamous cell component was found. From the second tumor, eight clones produced mixed tumors and two produced squamous cell carcinomas in which no adenocarcinoma component was found. The mixed tumors derived form clones contained widely varying proportions of adeno and squamous components. Recloning of the cloned lines yielded populations that produced mixed adenosquamous cell carcinomas upon inoculation in vivo. Comparison of tumor phenotypes from clones of early and late passages further confirmed the instability of differentiation in these neoplastic epithelial cells. These studies strongly suggest that the mixture of differentiated cell types in adenosquamous cell carcinomas is not the result of a mixture of stem cells with one fixed phenotype within the tumor, but rather is the result of an instability of differentiation; the neoplastic cells can express both types of differentiation.

Noninvasive precursor lesions of adenocarcinoma and mixed adenosquamous carcinoma of the cervix uteri.

It is postulated that squamous cell carcinoma, adenocarcinoma, and mixed adenosquamous cell carcinoma of the uterine cervix all have a common cell or origin, the subcolumnar reserve cell. The relative frequency with which the various types of carcinoma in situ are seen is in part explained by the ubiquitous nature of squamous metaplasia in the region of the transformation zone in women of reproductive age. It is suggested that squamous metaplasia is the soil on which most squamous carcinomas of the cervix evolve. The relatively low frequency with which adenocarcinoma and adenosquamous carcinoma in situ are encountered may also be dependent on their less accessible location in the endocervix.

Endometrial carcinoma in gonadal dysgenesis with and without estrogen therapy

Two phenotypically female patients with gonadal dysgenesis who developed endometrial carcinoma are described. One patient has not received exogenous estrogen therapy. No such patient has been reported previously. This patient developed the unusual mixed adenosquamous carcinoma. Both carcinomas were detected at an early age. It is postulated that the carcinomas developed essentially because of unopposed endogenous estrogen secretion due to anovulation.

OESTROGEN EXCRETION AND OVARIAN PATHOLOGY IN POSTMENOPAUSAL WOMEN WITH ATYPICAL HYPERPLASIA, ADENOCARCINOMA AND MIXED ADENOSQUAMOUS CARCINOMA OF THE ENDOMETRIUM

Summary Urinary oestrogen and pregnanediol excretion were measured before and after hysterectomy and bilateral salpingo-oophorectomy in 26 postmenopausal women with adenocarcinoma of the endometrium, 10 postmenopausal women with mixed adenosquamous carcinoma and 11 postmenopausal women with atypical hyperplasia (the patient groups). The results were compared with the values obtained in 22 active postmenopausal women, 20 hospitalized postmenopausal women and 18 women who had been subjected to hysterectomy and bilateral salpingo-oophorectomy for cancer of the cervix (the control groups). The ovaries and Fallopian tubes obtained at operation were examined for evidence of current or past excessive oestrogen production. Preoperative oestrogen values were higher in the patient groups than in the controls and the elevated values persisted after oophorectomy. The implications of these findings are discussed.

Glassy cell carcinoma of the cervix.

A clinicopathologic analysis of 13 cases of glassy cell carcinoma of the uterine cervix is presented. The glassy cell carcinoma is considered to be a poorly differentiated mixed adenosquamous carcinoma. Its histologic appearance is distinctive, being characterized by cells with a moderate amount of cytoplasm having a ground glass or finely granular appearance, a distinct cell wall that stains with eosin and PAS, and enlarged nuclei with prominent nucleoli. In the present study this tumor was associated with extrapelvic spread in 6/13 cases at diagnosis. Results were poor with either surgery and/or radiotherapy. Only four of 13 patients survived 5 years. The glassy cell carcinoma appears to be a distinct clinicopathologic entity which warrants a place in the classification of carcinoma of the cervix.