Minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix: clinicopathological analysis of 17 cases

OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of minimal deviation adenocarcinoma (MDA) and to analyze its prognostic factors. METHODS: We retrospectively analyzed the medical records of 17 patients who were diagnosed with MDA at a single institution between January 2005 and December 2015. RESULTS: The median age of the patients was 47.7 years (33–75 years). MDA was diagnosed in 7 patients (41.2%) before performing definitive surgery. Stage IB disease was diagnosed in 12 patients (70.6%) and advanced stage disease (stage II: 3, stage III: 2) in 5. MDA was incidentally diagnosed following hysterectomy for benign conditions in 6 patients. Adjuvant therapy was administered to 13 patients (76.5%). During median follow-up over 33.6 months (7–99 months), 11 patients (64.7%) showed no evidence of disease, 6 (35.3%) showed persistent or recurrent disease and 5 died of the disease. Peutz-Jeghers syndrome was not suspected in any patient, and no mutation was detected in the 3 patients who underwent genetic testing. Univariate analysis showed that advanced stage disease (P=0.016) and lymphovascular space invasion (P=0.002) demonstrated a statistically significant association with poor overall survival (OS) rates. Advanced stage disease continued to show a significant association with poor OS rates (hazard ratio, 2.92; 95% confidence interval, 1.097–7.746; P=0.032) even after multivariate analysis. CONCLUSION: Early diagnosis is important to manage MDA. Clinicians should consider MDA among the differential diagnoses in patients with a suspicious clinical presentation even with negative cervical screening tests.

Analysis of clinical and pathological features of minimal deviation adenocarcinoma of the ;cervix / 中国医师进修杂志

Objective To analyze the clinical and pathological data of the minimal deviation adenocarcinoma (MDA) of the cervix, and to provide evidence based medicine for diagnosis and treatment. Methods Clinical case reports about MDA or malignant adenoma during 1980-2014 published on CNKI, WanFang, CBM, WeiPu and Medline were retrieved and combined with 2 case with the same diagnosis and treatment. Results Age of onset was 20-86 years old, and the average age was 44.8 years, with median age of 44.5 years. Clinical symptoms of MDA showed massive vaginal apocenosis or irregular bleeding. Gynecological examination common showed cervical hypertrophic and harden. The positive rate of cervical cytology examination was 9.73% (11/113). MDA diagnosed by cervical biopsy and conization accounted for 58.38% (108/185). Immunohistochemical showed that the positive rates of carcinoembryonic antigen, P53 and Ki-67 were 93.91%(108/115), 75.44%(43/57)and 100.00% (42/42). Main operation assisted with postoperative radiotherapy and chemotherapy, early diagnosis, clinical stage and operation methods played important roles in the prognosis. Conclusions The clinical symptoms and physical signs are not obvious for MDA which is difficult to diagnose, so it is easy to diagnose mistakenly and misdiagnose also. The positive rate of cervical cytology is usually lower, repeated and deep cervical biopsy or conization combined with immunohistochemistry can improve the accuracy of diagnosis. The individualized treatment should be selected according to clinical stage for the patients who were confirmed preoperatively.

Minimal deviation adenocarcinoma of the cervix and tumorlets of sex-cord stromal tumor with annular tubules of the ovary in Peutz-Jeghers syndrome / 부인종양

We report 2 cases of minimal deviation adenocarcinoma of the cervix and tumorlets of sex cord tumor with annular tubules (SCTATs) of the ovaries, accompanied by Peutz-Jeghers syndrome. Case 1 is a 36-year-old woman and case 2 is a 35-year-old woman. Grossly, the cervix of both cases showed markedly barrel shaped enlargement with an infiltrating tumor. Microscopically, well-differentiated atypical glands were infiltrating into the entire thickness of the cervix. The ovarian masses in case 1 were diagnosed as metastatic carcinoma in mucinous cystadenoma with tumorlets of SCTATs of the ovaries. Multiple scattered tumorlets of SCTATs were also found in the ovary of case 2. By direct DNA sequencing analysis, a frame shift mutation of the STK11/LKB1 gene was identified in case 1. Case 1 represented the more aggressive clinical course, and although the patient received additional combined chemo-radiation therapy, she expired 1 year later. In general, mutation of the STK11/LKB1 gene is associated with poor clinical outcome in malignant tumors accompanied by Peutz-Jeghers syndrome.

Clinicopathlogic analysis of micro-unsymmetrical adenocarcinoma and microglanular prolierfation in cervix / 中国综合临床

Objective To discuss the features,such as clinical symptoms,pathologic morphologies,immunohistochemical staining of minimal deviation adenocarcinoma and microglandular hyperplasia of the uterine cervix in order to improve the accuracy of pathological diagnosis.Methods s:Histopathologic characteristics of total hysterectomies in 2 cases of minimal deviation adenocarcinoma and 1 case of cervical microglandular hyperplasia based on the formalin-fixed,paralfin-embedded and hematoxylin-eosin stained tissue were analyzed retrospectively.Immunohistochemical staining was used to detect the expression of CEA,p53,PCNA,and Ki-67 in all 3 cases.Results The main clinical symptoms of minimal deviation adenocarcinoma were watery leucorrhea and enlargement of the cervix.The pathological findings of MDA included hyperplasia of the glands with cytological minimal atypia,invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes,or edema and inflammatory infiltration around the glands were also observed.The invasion presented in the deep part of the cervix as well.The patiant of MGH had a history of oval contraceptive use.Histological features of MGH included tightly packed glands in different sizes and shapes,presentation of inflammatory cells in stroma and glandular lumens,and focal epithelial cell pleomorphism and hyperchromatism but without mitosis.CEA was positive in all two MDA cases,but the tissue of MGH was negative for CEA.The expressions of the other four markers had no difference between MDA and MGH.Conclusions For patients with watery discharge and/or hypertrophy of cervix,the deep ( ＞ 5 mm ) biopsies should be performed.The immunohistochemical staining for CEA,p53,CA125 and ER has adjuvant diagnostic values.It is extremely important to recognize that MGH is an entirely benign lesion.

A Case of Adenoma Malignum of the Uterine Cervix / 대한산부인과학회지

Adenoma malignum (minimal deviation adenocarcinoma) is an extremely well-differentiated adenocarcinoma of uterine cervix. Despite its benign histological appearance, this tumor is thought to be malignant and has a poor prognosis. Because Pap smear and punch biopsy have low sensitivity, accurate diagnosis of the tumor may be difficult. If it is diagnosed, it must be treated same as in cervical cancer. We presented one case of preoperatively diagnosed adenoma malignum by deep cone biposy with a brief review of literature.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.

A clinicopathological study on minimal deviation adenocarcinoma of uterine cervix / 肿瘤研究与临床

Objective To investigate the clinical and pathological characters and seize the diagnostic main points of minimal deviation adenocarcinoma of cervix to improve the accuracy of pathological diagnosis. Methods A clinic pathological review of 6 cases with minimal deviation adenocarcinoma was analyzed retrospectively. Results The main clinical symptoms were watery leucorrhagia, enlargement of the cervix with erosin and hardening. The pathological findings included hyperplasic and mild abnormality of the glands, invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes, or edema and inflammatory infiltration around the glands were also observed. Conclusion The detection rate of minimal deviation adenocarcinoma may increase by triple combination of clinic, cytology and histology.