Villoglandular Adenocarcinoma Research Articles

PD-L1 Expression and Silva Invasion Pattern in Villoglandular Adenocarcinoma of the Uterine Cervix.

Villoglandular adenocarcinoma (VGA) of the uterine cervix is a rare subtype of endocervical adenocarcinoma in young women. Between 2007 and 2020, all women with endocervical adenocarcinoma were retrospectively reviewed to find patients with VGA. Eight patients in whom pure VGA had been diagnosed were included. The mean age at initial diagnosis was 36.3 years (range 24-46). After surgical treatment, patients were followed up for 59 months (range 16-150). To date, all patients are alive with no evidence of disease. Neither lymph node involvement nor lymphovascular invasion was found. Furthermore, we examined the samples with a focus on morphological invasion pattern (Silva), stromal tumor-infiltrating lymphocytes (sTILs), and immunohistochemical programmed death ligand-1 (PD-L1) expression. PD-L1 expression was observed in 7/8 using the combined positive score (cutoff≥1%), 1/8 of VGAs using the tumor proportion score (cutoff≥1%), and 7/8 using the immune cell (cutoff≥1%). Using combined positive score and immune cell, PD-L1 expression was seen in 7/8 of pattern B and C tumors, with significantly higher expression in tumors with destructive-type patterns ( P <0.05, A vs. B+C). Using tumor proportion score, no significant difference in PD-L1 expression was seen between VGAs with different invasion patterns. VGAs demonstrated twice higher sTILs in tumors with destructive-type invasion patterns. Our observations suggest that PD-L1 expression, tumor invasion patterns, and sTILs do not correlate with the excellent prognosis of pure VGA.

Villoglandular Pattern in HPV-associated Endocervical Adenocarcinoma is Associated With Excellent Prognosis: A Reappraisal of 31 Cases Using IECC and Silva Pattern Classification.

Villoglandular adenocarcinoma of the cervix is a rare histologic entity that typically develops in young women, characterized by an association with oral contraceptives and excellent prognosis, though this point is controversial. These tumors have not been studied in the context of the International Endocervical Adenocarcinoma Criteria and Classification (IECC) or Silva Pattern Classification. We analyzed 31 cases that met strict diagnostic criteria, including being completely excised with negative margins. These were categorized according to IECC and Silva Pattern Classification and the association with various pathologic parameters analyzed. Most patients were young with a mean age of 41.1 (range 25-79). There were 14 (45.2%) pattern A, 11 (35.5%) pattern B, and 6 (19.3%) pattern C cases. Only 1 of 22 patients (4.5%) presented with lymph node metastasis at the time of diagnosis (pattern C, stage IB1) and 3 (9.7%) had lymphovascular invasion (2 pattern C, 1 pattern B). Overall survival was 100%, while recurrence-free survival was 96.2% for the entire cohort with only 1 case (3.2%) recurring 25mo after surgery (IB2, pattern B). Kaplan Meier analysis (log rank test) revealed no significant correlation for recurrence-free survival at 5 and 10yr associated with depth of invasion, tumor size, Silva pattern, FIGO stage, lymphovascular invasion, or lymph node metastasis. Cox univariate analysis demonstrated no independent prognostic factors predicting recurrence-free survival. These results indicate that completely excised villoglandular adenocarcinoma generally has an excellent prognosis and when Silva Pattern Classification is applied, those tumors that potentially have a higher chance for adverse outcomes can be identified.

Cervical villoglandular adenocarcinoma: a rare case report and review of the literature

Cervical villoglandular adenocarcinoma: a rare case report and review of the literature

Well Differentiated Villoglandular Papillary Adenocarcinoma of the Cervix: A Rare Case Report

The Villoglandular papillary adenocarcinoma (VGA) is a variant of adenocarcinoma of the cervix. It occurs in young women having a favorable prognosis. Pathologically, VGA poses a diagnostic challenge. Here we present a rare case of a middle-aged female patient complaining of bleeding per vagina since1year. Histopathological examination reported it as a well-differentiated villoglandular adenocarcinoma of the cervix. This tumor as a separate entity should be recognised, distinguished from other variants of adenocarcinomas. Because of its good behaviour and favourable prognosis usually itsallow conservative treatment.

Clinical features and prognostic factors of cervical villoglandular adenocarcinoma

BackgroundVilloglandular adenocarcinoma is a rare sub-type of cervical adenocarcinoma.ObjectiveTo analyze the clinicopathological features and evaluate the prognosis of patients with villoglandular adenocarcinoma of the cervix.MethodsPatient characteristics, procedure, pathology, and surgical...

Villoglandular Papillary Adenocarcinoma With Cervical Intraepithelial Neoplasia 3 of the Cervix in a Woman With a Misdiagnosis of a Cervical Polyp

We report a case in which a polypoid lesion with a diameter of 5 mm was diagnosed as a cervical polyp due to a negative Papanicolaou (Pap) smear in the cervix, and polypectomy revealed a diagnosis of villoglandular papillary adenocarcinoma (VGA) on histopathological examination. A 63-year-old woman with a cervical polyp, who had no abnormal symptoms and a negative Pap smear was referred to our hospital. We performed cervical polypectomy, and the pathological result was VGA with cervical intraepithelial neoplasia (CIN) 3. Even if an asymptomatic cervical polyp with a negative Pap smear is diagnosed, in some patients VGA of the uterine cervix may coexist with CIN. Therefore, asymptomatic cervical polyps with negative Pap smears should not be followed up without removal. J Med Cases. 2020;11(12):407-410 doi: https://doi.org/10.14740/jmc3589

Villoglandular adenocarcinoma of the cervix: A retrospective review of 60 cases

Objective: The objective of the study was to analyze the clinicopathologic features and prognosis of patients with villoglandular adenocarcinoma (VGA) of the cervix. Management of this variant of cervical adenocarcinoma is discussed.

Tumor Handling of Early-stage Cervical Cancer: A Literature Analysis of Villoglandular Adenocarcinoma of the Cervix.

Recent studies have demonstrated the inferior overall survival outcomes of patients with early-stage cervical cancer who undergo minimally invasive surgery (MIS). One possible explanation for these unexpected results is intraoperative tumor manipulation. Considering this hypothesis, we have reviewed the literature on the oncological outcomes of patients with villoglandular adenocarcinoma (VGA) of the cervix, an uncommon variant of cervical cancer that has an excellent prognosis. VGA generally presents as an exophytic mass arising from the endocervix. In a systematic review, we identified 221 patients treated surgically for VGA (FIGO stage Ia-Ib1). Of these, 11 developed recurrence, and four died. The recurrence sites in 8 cases were the pelvis (n=3), vaginal cuff (n=3), episiotomy scar (n=1), and cervix (n=1). Furthermore, 23 VGA-patients were treated by MIS, four experienced recurrence, and one died. Three intraabdominal metastases after MIS were reported. Excessive tumor-handling during MIS or manipulations, e.g. cervix-dilation (during delivery), can worsen the otherwise excellent prognosis.

Villoglandular adenocarcinoma of uterine cervix during pregnancy

Villoglandular adenocarcinoma of uterine cervix during pregnancy

Villoglandular Adenocarcinoma of Urethra with Negative CK7 Marker: Rare Disease in Atypical Location

Experimental Techniques in Urology & Nephrology Villoglandular Adenocarcinoma of Urethra with Negative CK7 Marker: Rare Disease in Atypical Location Matheus WE*, Ferruccio AA, Matheus MB, Almeida Braga D and Ferreira U Departments of Surgery and Division of Urology, Brazil *Corresponding author: Matheus WE, From the Departments of Surgery and Division of Urology, School of Medical Sciences, Brazil Submission: August 05, 2019;Published: September 19, 2019 DOI: 10.31031/ETUN.2019.03.000551 ISSN 2578-0395Volume3 Issue1

Could E-Cadherin and CD10 Expression be Used to Differentiate Between Atypical Endometrial Hyperplasia and Endometrial Carcinoma?

Endometrial carcinoma contributes to morbidity and mortality among female individuals worldwide. The role of E-cadherin expression, as an adhesion molecule, in endometrial carcinoma is controversial. Moreover, the role of CD10-expressing stromal cells in endometrial carcinoma is still unclear. The aim of this work was to evaluate E-cadherin and CD10 expression in normal endometrium, atypical endometrial hyperplasia, and endometrial carcinoma, and assess their role to differentiate atypical endometrial hyperplasia from endometrial carcinoma. The association of E-cadherin and CD10 expression with clinicopathologic parameters of endometrial carcinoma was also determined. This retrospective study was carried out on 80 cases including 36 cases of endometrial adenocarcinoma (all were of endometrioid type), 34 cases of atypical endometrial hyperplasia, and another 10 cases of normal endometrial tissue. Immunohistochemistry for E-cadherin and CD10 was conducted. The studied patients were in their sixth and seventh decades of life with a mean age of 60.97 yr. Most of the carcinoma cases (18 cases) were grade 1, 10 cases were grade 2, and only 2 cases were grade 3. With regard to International Federation of Gynecology and Obstetrics (FIGO) staging, 28 cases were stage I, and only 2 cases were stage II. E-cadherin in normal endometrial tissue and atypical hyperplastic endometrial tissue showed predominantly membranous homogenous reactivity, and CD10 was detected as membranocyptoplasmic staining. However, we noticed the subcellular change of E-cadherin reactivity to be heterogenous and predominantly membranocytoplasmic in endometrial carcinoma, whereas CD10 remained membranocytoplasmic. Concerning E-cadherin expression, there was a statistically significant relationship between E-cadherin expression, tumor grade and FIGO staging, whereas there was an insignificant relationship between E-cadherin expression and patients' age, specimen type, tumor gross pattern, and histopathologic types. With regard to CD10 expression, there was a statistically significant relation between CD10 expression and tumor grade and FIGO staging with insignificant relation with patients' age, tumor gross pattern, specimen type, and tumor histologic types (villoglandular vs. usual endometrial adenocarcinoma). There was also a highly statistically significant positive relationship between E-cadherin expression and CD10 expression. This study puts the spot light on their role in differentiating between atypical endometrial hyperplasia and endometrial carcinoma, which is often difficult.

Villoglandular adenocarcinoma of cervix: pathologic features, clinical management, and outcome

BackgroundThe objective of the study was to investigate the management and prognosis of patients with villoglandular adenocarcinoma (VGA) of the uterine cervix.Materials and methodsThe clinical presentation, pathology, management, and prognosis of 41 patients with VGA or other types of cervical adenocarcinoma (ADC) were retrospectively reviewed.ResultsDuring the patient follow-up period, the proportion of VGA was 8.1% in the cervical ADC cohort (41/507). The median age of the patients with VGA was 41.0 years. The most common presenting symptom was cervical contactive bleeding. There were 38 patients classified as FIGO stage IA1–IB. The median follow-up period was 38.5 months. There were no patient deaths, and only one patient showed recurrence. One of the patients delivered a healthy baby at 34 weeks of gestation prior to treatment with radical hysterectomy. The HPV HC2 test results showed that most patients were positive for HPV infection. HPV 16, 18, and 56 were positive in the 8 patients with HPV type test results. There were significant differences in the grade, depth of stromal invasion, lymph node metastasis, and recurrence between the VGA cases of FIGO stage I and the other types of cervical ADC of FIGO stage I (p<0.05).ConclusionThis study confirmed that VGA is a type of well-differentiated cervical cancer characterized by shallow stromal invasion, less lymph node metastasis. VGA is associated with less recurrence than other types of cervical ADC.

A Retrospective Review of 10 Cases of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix Including One with Successful Pregnancy

Objective: Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a subtype of cervical adenocarcinoma. In the present study, we summarized the clinical features of VGPA of the uterine cervix and discussed the potential indications for a conservative treatment. Methods: A retrospective review of clinical characteristics and treatment aspects of 10 patients with VGPA at the Obstetrics and Gynecology Hospital of Fudan University was conducted between January 2007 and December 2016. Almost all of the existing 40 English papers on “villoglandular papillary adenocarcinoma [title/abstract]” identified from PubMed were obtained. Clinical data from these papers were analyzed in terms of age, International Federation of Gynecology and Obstetrics (FIGO) stage, recurrence rate, mortality, and conservation treatment aspects. Results: The median age of 10 patients with VGPA was 40 years. All cases had Stage IB 1 disease. Seven patients underwent human papillomavirus examinations, which revealed 6 positive and 1 negative case(s) of infection. Six patients underwent ThinPrep cytologic tests, which revealed 4 patients with atypical glandular cells, 1 with a high-grade squamous intraepithelial lesion, and 1 who tested negative for intraepithelial malignancy. None of the patients had lymph node metastases. During the 6–114 months of follow-up, no disease recurrence or death occurred. Of note, one patient who received conservative treatment successfully became pregnant. Conclusions: VGPA can be detected at an early FIGO stage with excellent prognosis. For young patients who do not exhibit poor prognosis factors, conservative treatment may be the first treatment choice based on overall assessment of clinical conditions.

The clinicopathologic and immunohistochemical features of villoglandular adenocarcinoma of uterine cervix.

Villoglandular adenocarcinoma (VGA) of the uterine cervix is a variant of endocervical adenocarcinoma. However, the clinicopathologic and immunohistochemical features of VGA are still unclear. The aim of this study was to investigate the clinicopathologic and immunohistochemical features of VGA. A total of 20 VGA patients were identified among 852 patients diagnosed with cervical cancer and enrolled in this study. The immunohistochemical levels of Ki-67, P53, P16, progesterone receptor (PR), carcinoembryonic antigen (CEA), vimentin (Vim), and estrogen receptor (ER) were measured by immunohistochemistry. VGA was prevalent in younger women and presented favorable prognosis. Ki-67, P16, and CEA were highly expressed in VGA tissues, while PR expression was hardly to be detected. The positive rates of Ki-67, CEA, and P16 were 90.0%, 90.0%, and 85.0%, respectively, which were significantly higher compared with PR (5.0%, P < 0.001). In addition, the positive rates of P53, Vim, and ER in VGA tissues were 55.0%, 50.0%, and 40.0%, respectively. However, the expression levels of Ki-67, P53, P16, PR, CEA, Vim, and ER were not significantly associated with clinical features (P > 0.05). These data indicate that VGA is a rare cervical adenocarcinoma, which is prevalent in younger women, and presents favorable prognosis. Detection of Ki-67, P53, P16, PR, CEA, Vim, and ER would be beneficial for the diagnosis of VGA.

Is the ovarian preservation safe in young women with stages IB-IIA villoglandular adenocarcinoma of the uterine cervix?

ObjectiveBecause villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA.MethodsWe retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015.ResultsThis study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa.ConclusionThis study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.

Vulvar Villoglandular Adenocarcinoma of Colonic Type: A Rare Finding

Colonic type villoglandular adenocarcinoma of the lower genital tract is an extremely rare condition. Its origin is not clearly understood; however, the cloacal remnants are the more accepted source for this carcinoma.We report the case of a 67-year-old female patient who presented with a 1.2 cm polypoidal nodule at the right side of the fourchette. Morphologic studies revealed a colonic type mucinous adenocarcinoma that arose from within a villous adenoma. Immunohistochemical staining showed positive cytokeratin 7, cytokeratin 20, carcinoembryonic antigen, P53, and progesterone receptor, but negative for estrogen receptor and caudal type homeobox transcription factor 2. Extensive work-up failed to reveal other primary cancers in this patient. Ultimately, she underwent a radical vulvectomy. No recurrence was seen in eight months follow up of this patient after surgery. Careful, thorough histological evaluation and clinical clues enable correct diagnosis of the rare colonic type vulvar villoglandular adenocarcinoma. Due to rarity of this tumor, its management is questionable. Therefore, additional investigation is necessary for its management.

Villoglandulary papillary adenocarcinoma co-existing with high-grade squamous intraepitelial lesion; arising from an endocervical polyp

Adenocarcinomas account for 10–20% of invasive cervical carcinomas. The villoglandular papillary adenocarcinoma has been recognized as a subtype of mucinous adenocarcinoma and identified as a distinctive histological entity from the usual invasive adenocarcinomas of the uterine cervix. We report a new case of villoglandulary papillary adenocarcinoma, which was peculiar because of its association with a co-existing high grade squamous intraepithelial lesion and arising from an endocervical polyp. Excellent prognosis of isolated villoglandulary papillary adenocarcinoma is important in terms of making differential diagnosis from other adenocarcinomas and eliminating unnecessary aggressive treatments. It is also important to keep in mind for pathologists since it allows them to examine endocervical polyps that we often encounter in daily life and shows that malignant tumoral lesions can develop from polyps.

Importance of cytology in the identification of villoglandular adenocarcinoma

Endocervical villoglandular adenocarcinoma is a rare subtype of cervical adenocarcinoma. It arises mainly in young and reproductive age women and it has a lower incidence and better prognosis compared to cervical adenocarcinoma. The present case study refers to a conventional cytology performed on a 48-year-old woman within a screening program carried out at a health center of the Local Health Unit of Matosinhos. The objective of this study is to verify the importance of the cytological sample collection method for a better observation and interpretation of the cytological findings in rare neoplastic entities, as well as to reinforce the importance of the application of complementary tests for the elaboration of a conclusive diagnosis. The cytological result of the present case report was atypical glandular cells (AGC) of the endocervical type. Subsequently, a biopsy of the uterine cervix, a conization and a curettage of endocervix were performed, whose histological diagnosis was well differentiated villoglandular adenocarcinoma from the endocervix.

A retrospective review of 11 cases of villoglandular papillary adenocarcinoma of the uterine cervix and a review of the literature.

Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a rare subtype of cervical adenocarcinoma (AC) that accounts for 3.7-4.8% of cervical AC. Compared with ordinary adenocarcinoma, VGPA is associated with a lower incidence, younger age and better prognosis. Treatment with fertility-preserving surgery is also possible. The present study analyzed cases treated in The Second Hospital of Jilin University (Changchun, Jilin, China) between January 2010 and December 2014. A total of 11 cases were selected; of these, 7 cases were pathologically confirmed. The remaining 4 cases were diagnosed as VGPA upon the pathological examination of the biopsy, but confirmed as another type of adenocarcinoma upon analysis of the surgical pathology. The median age of the patients whose pathology was confirmed post-operatively was 36 years, and all cases were positive for human papillomavirus (HPV). As all 7 patients had no requirement for further fertility, a radical hysterectomy was performed, with or without adjuvant therapy. The follow-up time ranged from 7-57 months, with a mean time of 29 months. There was no evidence of recurrence in any of the patients. All the patients remain alive to date. The results of the present study indicated that HPV infection is likely to be the cause of VGPA, and the prognosis of VGPA tends to be better compared with other types of adenocarcinoma. However, the number of studies that have reported cases of VGPA remains small, and all are retrospective analyses with short follow-up times. Therefore, physicians selecting treatment options for patients with VGPA should exercise caution.

Villoglandular papillary adenocarcinoma of the uterine cervix: A report of 4 cases and a review of the literature.

To investigate the clinicopathological features, management and prognosis of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix, the current study presents 4 cases of VGPA of the uterine cervix. The median age of the patients was 55 years (range, 47-70 years), with all 4 patients presenting with stage Ib disease. Human papillomavirus (HPV) infection was detected in 3 patients; this was mainly HPV-16. No history of oral contraceptive use was found in these cases. While 2 of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, 1 patient underwent a radical hysterectomy with bilateral pelvic lymphadenectomy and the remaining patient received a simple total hysterectomy plus post-operative radiotherapy. Of these patients, only 1 had been correctly diagnosed pre-operatively. In 2 patients, the biopsy results had been interpreted as cervical adenocarcinoma, and in the third, the biopsy result was of cervical intraepithelial neoplasia. All 4 patients presented with cervical wall invasion, including invasion of the inner two-thirds in 1 patient. No lymphovascular space invasion or lymph node metastasis was detected. The follow-up time ranged from 49 to 83 months (median, 64 months), and the patients are currently alive and well, with no evidence of recurrent disease. Taking these results as a whole, VGPA is an uncommon type of cervical adenocarcinoma, characterized by its excellent prognosis. HPV infection is associated with the molecular pathogenesis of VGPA, while oral contraceptive use can be excluded. As the disease has a low pre-operative diagnostic accuracy, frequent cervical wall invasion and concomitant lesions, conservative treatment strategies should be carefully considered.