Villoglandular Adenocarcinoma Research Articles

Villoglandular Adenocarcinoma In Situ of Intestinal Type of the Hymen

Adenocarcinomas of the lower genital tract are rare diseases, and most of them arise from the Bartholin glands. Villoglandular adenocarcinoma of intestinal type is a very uncommon neoplasm of unknown origin with only few cases described on the vulva and in the vagina. It is characterized by villoglandular architecture, mucinous-type epithelium with intestinal differentiation (goblet cells), and direct apposition of the tumor with the surface epithelium. We report a case that developed on the hymen of a 64-year-old woman and discuss its possible origin as arising de novo from the squamous epithelium.

A three-dimensional multivariate image processing technique for the analysis of FTIR spectroscopic images of multiple tissue sections

BackgroundThree-dimensional (3D) multivariate Fourier Transform Infrared (FTIR) image maps of tissue sections are presented. A villoglandular adenocarcinoma from a cervical biopsy with a number of interesting anatomical features was used as a model system to demonstrate the efficacy of the technique.MethodsFour FTIR images recorded using a focal plane array detector of adjacent tissue sections were stitched together using a MATLAB® routine and placed in a single data matrix for multivariate analysis using Cytospec™. Unsupervised Hierarchical Cluster Analysis (UHCA) was performed simultaneously on all 4 sections and 4 clusters plotted. The four UHCA maps were then stacked together and interpolated with a box function using SCIRun software.ResultsThe resultant 3D-images can be rotated in three-dimensions, sliced and made semi-transparent to view the internal structure of the tissue block. A number of anatomical and histopathological features including connective tissue, red blood cells, inflammatory exudate and glandular cells could be identified in the cluster maps and correlated with Hematoxylin & Eosin stained sections. The mean extracted spectra from individual clusters provide macromolecular information on tissue components.Conclusion3D-multivariate imaging provides a new avenue to study the shape and penetration of important anatomical and histopathological features based on the underlying macromolecular chemistry and therefore has clear potential in biology and medicine.

A 54-Year-Old Woman With Menorrhagia

The principal differential considerations for papillary carcinomatous proliferations of the endometrium have traditionally been uterine papillary serous carcinoma and villoglandular adenocarcinoma. Recently, another variant of endometrioid carcinoma that may also show papillary structures was described and designated endometrioid carcinoma with small nonvillous papillae (SNVP). In contrast to the papillary structures of uterine papillary serous carcinoma, the SNVP have cells that lack a high nuclear-to-cytoplasmic ratio and typically show exuberant eosinophilic cytoplasm. Additionally, the other typical morphologic patterns of uterine papillary serous carcinoma, such as slitlike spaces, highly pleomorphic nuclei, small detached cell clusters, and psammoma bodies, are absent. Overall, the clinicopathologic characteristics of this tumor are more consistent with endometrioid carcinoma and as such should be clearly distinguished from uterine papillary serous carcinoma. Herein, we report an example of a mixed mucinous and endometrioid carcinoma with prominent SNVP in both components.

A 54-year-old woman with menorrhagia. Mixed mucinous and endometrioid carcinoma with small nonvillous papillae.

The principal differential considerations for papillary carcinomatous proliferations of the endometrium have traditionally been uterine papillary serous carcinoma and villoglandular adenocarcinoma. Recently, another variant of endometrioid carcinoma that may also show papillary structures was described and designated endometrioid carcinoma with small nonvillous papillae (SNVP). In contrast to the papillary structures of uterine papillary serous carcinoma, the SNVP have cells that lack a high nuclear-to-cytoplasmic ratio and typically show exuberant eosinophilic cytoplasm. Additionally, the other typical morphologic patterns of uterine papillary serous carcinoma, such as slitlike spaces, highly pleomorphic nuclei, small detached cell clusters, and psammoma bodies, are absent. Overall, the clinicopathologic characteristics of this tumor are more consistent with endometrioid carcinoma and as such should be clearly distinguished from uterine papillary serous carcinoma. Herein, we report an example of a mixed mucinous and endometrioid carcinoma with prominent SNVP in both components.

Successful term delivery following conservative management for villoglandular papillary adenocarcinoma of the uterine cervix: A case report

Background.Villoglandular papillary adenocarcinoma (VPA) is a rare subtype of adenocarcinoma of the uterine cervix. A conservative surgical approach is considered feasible. Only three cases of VPA and pregnancy have been reported. Case.A 34-year-old asymptomatic woman was diagnosed of a well-differentiated VPA without extracervical spread of the disease. A cold knife conization was performed. Five years later, the patient became pregnant. The pregnancy developed without complications and was finished with a caesarean delivery, due to nonreassuring fetal status. A healthy child was born. Last control 8 years later showed no evidence of disease. Conclusions.A successful pregnancy can be completed in patients with VPA without lymph-vascular invasion treated in a conservative way. This management is particularly desirable in young women to preserve reproductive capability.

Villoglandular adenocarcinoma of the cervix: Clarity is needed on the histological definition for this difficult diagnosis

Background. Villoglandular adenocarcinoma (VGA) of the cervix is reported as a variant of a cervical adenocarcinoma with a good prognosis. Cases. We present two cases histologically reported as a villoglandular adenocarcinoma of the cervix that have recurred and progressed rapidly since initial treatment. External histopathological review suggested both had a prominent villoglandular pattern but with an associated underlying well-differentiated adenocarcinoma. Conclusion. The diagnosis of VGA is difficult. Current literature is not entirely consistent in the presented definition, and further clarity is needed. Because of the rarity of VGA and the difficulty but importance of the diagnosis, we would feel that a central review of all cases of VGA is warranted. This would assist in diagnosis and also in obtaining accurate follow-up data.

Villoglandular papillary adenocarcinoma of the uterine cervix responding to neoadjuvant chemotherapy with docetaxel and cisplatin: a case report

Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a rare neoplasm, and its treatment has rarely been reported. We report a patient with VGPA stage IIA responding to neoadjuvant chemotherapy with docetaxel (60 mg/m2 as an intravenous infusion) and cisplatin (70 mg/m2 as an intra-arterial infusion). At 3 weeks after completing one course of this regimen, the tumor size was reduced from 5.3 x 4.0 cm to 2.0 x 2.0 cm (81.1% reduction), revealed by computed tomography. Accordingly, the patient underwent radical hysterectomy, and there have been no signs of recurrence. Thus, the combination of docetaxel and cisplatin is suggested to be useful for neoadjuvant chemotherapy of cervical adenocarcinoma.

Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix with a focal high-grade component: is there a need for reassessment?

Well-differentiated villoglandular adenocarcinoma of the uterine cervix is characterized by an exophytic growth pattern with variably sized papillae that are lined by stratified columnar cells with no more than moderate cytologic atypia. Based on the favorable outcomes in most of the previously reported cases, it has been suggested that some patients with this subtype may be managed conservatively. The case described herein is an otherwise prototypical well-differentiated villoglandular adenocarcinoma but which was associated with a 4.9-mm focus of poorly differentiated carcinoma at its invasive edge. A review of the literature revealed a variety of findings that suggests a need to reassess the potential morphologic and biologic spectrum of this group of tumors. Five of the approximately 89 reported cases were associated with a higher-grade component of the same or a different histologic subtype. At least one patient with apparently stage 1A1 disease was found to have a positive lymph node. Another patient with stage 1B1 disease but no stromal invasion died of her disease following multiple recurrences. Finally, the frequency of lymphovascular invasion and/or lymph node involvement in recent series far exceeds what was found in the two original series. Our case suggests that well-differentiated villoglandular adenocarcinoma is not a diagnosis that should be unequivocally rendered on a small biopsy since other components may be present and the patients may be undertreated. We urge caution when conservative management (cone biopsy alone when margins are negative and there is no lymphovascular invasion) is offered to patients with this tumor since knowledge about its true biologic spectrum appears to still be in evolution.

Villoglandular adenocarcinoma of the cervix recurrent in an episiotomy scar: a case report in a 32-year-old female

Cervical cancer during pregnancy is rare, occurring in approximately 3% of cervical cancer cases. Considerable controversy exists as to the long-term prognosis of patients diagnosed during pregnancy. A 32-year-old female presented with vaginal spotting in April 1998. A prenatal smear in December 1996 revealed atypical glandular cells of undetermined significance. A sterile speculum exam in April 1997 at 31-week gestational age revealed a polyp on the anterior lip of the cervix, pathology consistent with a well-differentiated villoglandular adenocarcinoma. In August 1997, the patient underwent a radical hysterectomy with pelvic/para-aortic lymphadenectomy. In April 2001, she represented with nodular perineal mass in the episiotomy incision. She received preoperative radiotherapy with a near-complete response and remained without disease for >10 months. It appears that a less radical procedure can offer significant therapeutic value. Preoperative radiotherapy proved effective at achieving a near-complete response. The patient underwent a wide local excision of the perineal area with resultant negative margins

Villoglandular adenocarcinoma of the cervix recurrent in an episiotomy scar: a case report in a 32-year-old female

Cervical cancer during pregnancy is rare, occurring in approximately 3% of cervical cancer cases. Considerable controversy exists as to the long-term prognosis of patients diagnosed during pregnancy. A 32-year-old female presented with vaginal spotting in April 1998. A prenatal smear in December 1996 revealed atypical glandular cells of undetermined significance. A sterile speculum exam in April 1997 at 31-week gestational age revealed a polyp on the anterior lip of the cervix, pathology consistent with a well-differentiated villoglandular adenocarcinoma. In August 1997, the patient underwent a radical hysterectomy with pelvic/para-aortic lymphadenectomy. In April 2001, she represented with nodular perineal mass in the episiotomy incision. She received preoperative radiotherapy with a near-complete response and remained without disease for >10 months. It appears that a less radical procedure can offer significant therapeutic value. Preoperative radiotherapy proved effective at achieving a near-complete response. The patient underwent a wide local excision of the perineal area with resultant negative margins.

Primary villoglandular adenocarcinoma of cloacogenic origin of the vulva

Primary villoglandular adenocarcinomas of the vulva are rare, and only seven cases have been described to date. Hypotheses about the origin of this neoplasm remain highly speculative. We report the case of a 58-year-old woman who developed this very uncommon malignant tumor. Immunohistochemical studies of the tumor revealed positive staining for cytokeratins 7 and 20 and a negative staining for estrogen and progesterone receptors. Special stains showed the presence of intracellular mucin. No other primary lesion was found on clinical evaluation and extensive investigation. The patient was first treated by radical hemivulvectomy, followed by ipsilateral inguinal lymph node dissection and laparoscopic right salpingo-oophorectomy for an incidental finding of an ovarian cyst. The patient remained free of disease 16 months after the initial surgery.

Adenocarcinoma villoglandular de cérvix: descripción de cuatro casos clínicos y revisión de la bibliografía

Villoglandular adenocarcinoma of the cervix is a type of adenocarcinoma characterized by its good prognosis and its development in young women. We present four cases of villoglandular adenocarcinoma. The mean age at presentation was 36 years (range: 25-47 years). The patients were treated by the following surgical procedures: simple abdominal hysterectomy, Wertheim-Meigs radical hysterectomy with bilateral pelvic lymphadenectomy in two patients and cervical conization. In all patients the tumor was confined to the cervix. The patients have remained disease-free after a followup of 5-48 months (mean 31.2 months).

Clinicopathologic features of villoglandular papillary adenocarcinoma of the uterine cervix

Objectives. The objectives of this study are to analyze the clinicopathologic features of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix and to discuss the management thereof. We examined 13 patients with VGPA. Methods. Clinical profiles, including patient age, clinical stage, surgical procedure, and outcome, were recorded. Pathologically, macroscopic features, polypoid tumor size, horizontal spread and depth of endophytic tumor, nuclear atypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis were investigated. Results. The median age of 13 patients was 45 years, with 10 and 3 patients staged Ib and IIb, respectively. All the patients underwent hysterectomy and pelvic lymphadenectomy and are alive without recurrence. Macroscopically, the tumor showed a polypoid pattern in 8 patients and a flat pattern in the remaining 5 patients. Polypoid tumor size ranged between 4 × 2 and 20 × 15 mm. Horizontal spread and depth of endophytic tumor ranged between 8 and 30 mm and between 3 and 11 mm, respectively. The tumor in all the 13 patients except 1 showed moderate nuclear atypicality. The mean mitotic count was 43/10 high-power fields. Lymph capillary space invasion was present in 4 patients, 1 of whom also had bulky lymph node metastases. Conclusions. VGPA has been reported to rarely involve lymph capillary space invasion or lymph node metastasis, leading some surgeons to conduct less radical surgeries such as conization. Nevertheless, we encountered patients with these pathologic risk factors. Much caution should be exercised in managing patients with VGPA.

Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis.

Adenocarcinoma of the uterine cervix and its variants account for a much greater number of cases in routine practice of histopathology than they did several decades ago. The varied morphology of these tumours results in diverse problems in differential diagnosis. The overall area of glandular pathology of the cervix, of which invasive adenocarcinoma is only one subset, is further complicated by the fact that there are many benign glandular proliferations of the cervix that can potentially be misinterpreted as adenocarcinoma. In this review the histopathology of endocervical adenocarcinoma and its variants is presented with the emphasis on evaluation of routinely stained sections, still the bedrock of routine practice, relatively little aid being provided by immunohistochemistry or other new techniques, contrary to what is sometimes implied in the literature. Description of the appearance of each subtype of adenocarcinoma or variant thereof is followed by a section on their differential diagnosis. Eighty percent of endocervical carcinomas are of the so-called usual type being characterized by cells with eosinophilic cytoplasm and generally brisk mitotic activity. It is sometimes stated that endocervical adenocarcinomas are mucinous but the usual form just noted often has little or no mucin. Pure or almost pure mucinous adenocarcinoma do occur, however, and have an important subtype, the so-called adenoma malignum (minimal deviation adenocarcinoma). Although treacherous because of its bland cytological features and sometimes deceptive pattern, a cone biopsy or hysterectomy specimen showing this neoplasm typically has easily recognizable features that indicate the presence of an infiltrative adenocarcinoma. An important variant of usual endocervical adenocarcinoma is the well differentiated villoglandular papillary adenocarcinoma, a designation that should be reserved for tumours with grade 1 cytologic features as usual endocervical adenocarcinoma, which is typically grade 2, may have papillae. In our opinion all other variants of pure adenocarcinoma, including endometrioid, are rare and include in addition to the latter clear cell, serous and mesonephric neoplasms. Tumours with a glandular and nonglandular component are also reviewed: adenosquamous carcinoma, glassy cell carcinoma, adenoid basal carcinoma, 'adenoid cystic' carcinoma and adenocarcinoma admixed with a neuroendocrine tumour.

Villoglandular papillary adenocarcinoma of the uterine cervix with bulky lymph node metastases

A patient with stage IIb cervical adenocarcinoma underwent Wertheim hysterectomy with pelvic lymphadenectomy and bilateral adenexectomy followed by radiotherapy. Review of histologic sections diagnosed villoglandular papillary adenocarcinoma (VGPA) with metastatic lymph nodes. The patient has been disease-free for 17 years. This patient is the third case of VGPA with lymph node metastasis ever reported.

Cervical implant from villoglandular endometrial adenocarcinoma masquerading as cervical villoglandular adenocarcinoma

Abstract.Al-Nafussi A, Obafunwa J, Jordan LB, Fulton I, Martin C, Beattie G. Cervical implant from villoglandular endometrial adenocarcinoma masquerading as cervical villoglandular adenocarcinoma.This is an unusual presentation of a rare subtype of endometrial adenocarcinoma (villoglandular papillary carcinoma, VGPC) in a 71-year-old woman, which was initially diagnosed on cervical biopsy as being primary cervical VGPC. Loop excision failed to show any evidence of residual disease. Subsequent hysterectomy revealed a localized villoglandular carcinoma involving the uterine fundus and invading the inner one-third of the myometrium, the background endometrium was atrophic. The remaining cervix contained a focus of papillary forming endometrial type adenocarcinoma involving the surface epithelium and the superficial subepithelial glands. In conclusion, VGPC of cervix occurs mainly in young women and can be treated conservatively, pathologists should be cautious in making such a diagnosis in a postmenopausal woman before ruling out a primary endometrial origin.

子宮頚部円錐切除術により治癒したじゅう毛腺管状乳頭腺癌の１例

子宮頚部円錐切除術により治癒したじゅう毛腺管状乳頭腺癌の１例

Villoglandular Adenocarcinoma of the Vulva

Background. Only two previous cases of villoglandular adenocarcinoma of the vulva, an entity morphologically similar to tumors found in the uterine cervix and colorectum, have been reported. This paper communicates the first complete immunohistochemical study in villoglandular adenocarcinoma in order to determine its phenotype and histogenesis.Case. A 69-year-old woman had a 1.5-cm nodule in the right labium majus. Histologically, it corresponded to a minimally atypical, villoglandular adenocarcinoma with a small microinvasion. Immunohistochemically, it was positive to OC125, CEA, and OC19.9 and coexpressed cytokeratins 7 and 20. Chromogranin, nuclear estrogen, and progesterone receptors were negative.Conclusion. Phenotypic expression was more consistent with a papillary mucinous ovarian or cervical neoplasm than of a colonic one. Its behavior was similar to that of its morphologic counterpart in the cervix, since the patient had no recurrence 3 years after a wide local excision.

Ovarian Endometriosis and Clear Cell Carcinoma, Leiomyomatosis Peritonealis Disseminata, and Endometrial Adenocarcinoma: An Unusual, Pathogenetically Related Association

A 42 year-old female with a preoperative clinical diagnosis of ovarian cancer underwent laparotomy which revealed leiomyomatosis peritonealis disseminata (LPD) in the peritoneum and omentum and a left ovarian endometriotic cyst associated with a clear cell carcinoma. A grade 1, superfically invasive villoglandular endometrial endometrioid adenocarcinoma was also found. Microscopically, the endometriotic cyst wall contained an extensive peripheral band-like condensation of stromal cells. These cells were strongly positive for alpha inhibin and may have been the hormonal source responsible for the induction of the simultaneous LPD and endometrial adenocarcinoma. It is proposed that endometriosis is not only a precursor of clear cell carcinoma but, through secondary hormonal induction of the surrounding ovarian stroma, may also provide a hormonal stimulus for diverse proliferative processes.

Term Delivery Following Conservative Treatment for Villoglandular Papillary Adenocarcinoma of the Uterine Cervix: Report of a Case and Analysis of the Literature

Background. Villoglandularpapillary adenocarcinoma (VPA) of the cervix is often indolent, and surgical treatment has a favorable outlook. Risk factors include depth of invasion, lymphovascular invasion, and the presence of other histologic types of cancer.Case. An amputation of the cervical portio was required to satisfactorily resect a 2.5-cm ectocervical lesion in a 28-year-old nulligravida. A diagnosis of pure VPA with a depth of invasion less than 2 mm was established. During a subsequent pregnancy, second trimester ultrasound showed extreme effacement of her cervix and an abdominal cerclage was placed. The pregnancy continued until delivery of a healthy infant at 36 weeks.Conclusions. In cases of tumor invasion less than 3 mm, and in the absence of lymphovascular space involvement, extrauterine spread of pure VPA has not been described. When conservative treatment is planned, amputation of the cervical portio may be better suited than conization to the achievement of an adequate margin of resection. Cervical cerclage may be needed to offset the extensive cervical surgery.