HPV-independent gastric type adenocarcinoma of the uterine cervix presenting as ovarian masses: A case report and review of literature

@#Adenocarcinoma, HPV-independent, gastric type of the uterine cervix comprises only 10-15% of all cervical adenocarcinomas. A rare case of which, with metastasis to the uterine corpus and bilateral ovaries, is described. A 43-year-old female (G0P0) presented with menorrhagia and right flank pain radiating to the hypogastrium. Physical examination revealed an immovable, tender mass at the right lower quadrant with a nodular, firm cervix. Transabdominal ultrasound revealed multiseptated ovarian masses. The right and left ovaries were sent for frozen section and was diagnosed as Mucinous Cystadenoma and Mature Cystic Teratoma, respectively. Hysterectomy revealed a detached and fragmented cervix with irregular, abnormally shaped glands lined by a single layer of columnar cells with bland, basally located nuclei and clear cytoplasm associated with desmoplasia, findings which were also seen in the endomyometrium and ovaries. These tumor cells were CK7 positive and negative for ER, PR, CK20 and CDX2. The patient died six months after surgery. The presence of benign appearing glands is a diagnostic challenge. Despite the appearance, they may be malignant and should be investigated rigorously.

Expression of alpha-methylacyl-CoA racemase in vaginal gastric-type adenocarcinoma and uterine clear cell carcinoma

Background: Alpha-methylacyl-coenzyme A racemase (AMACR, P504S) is a commonly used marker in immunohistochemical diagnosis of prostate cancer. Recent studies identified P504S markers of the clear cell histotype in the ovary and/or endometrium. Gastric-type adenocarcinoma (GAS) is difficult to diagnose histologically, particularly when there is crossover with clear cell carcinoma (CCC). However, the significance of P504S for differentially diagnosing GAS and CCC is unclear. Aim: To evaluate P504S as a potential diagnostic marker of GAS and CCC. Settings and Design: We analyzed P504S expression in 48 cervical carcinomas (32 GAS and 16 CCC), as well as the expression of other markers including hepatocyte nuclear factor-1 beta (HNF-1?) and NapsinA. Material and Methods: The expression differences of HNF-1?, NapsinA, and P504S in GAS and CCC were detected by immunohistochemistry. Immunohistochemical histoscores based on the intensity and extent of staining were calculated. Results: The positive rates of HNF-1? in GAS and CCC were 90.32% and 75%, respectively. (?2 = 2.251, P = 0.663). The positive rates of NapsinA in GAS and CCC were 19.36% and 81.25%, respectively. (?2 = 47.332, P < 0.01). The positive rates of P504S in GAS and CCC were 16.13% and 81.25%, respectively. (?2 = 41.420, P < 0.01). HNF-1? was frequently expressed in GAS and CCC, while NapsinA and P504S were frequently expressed in CCC, and reduced or lost in GAS. Conclusion: NapsinA and P504S can be used to differentiate between GAS and CCC.

Gastric type mucinous endocervical adenocarcinoma of the uterine cervix: very rare and interesting case

Gastric type mucinous endocervical adenocarcinomas of the uterine cervix (GAC) are a newly classified mucinous subtype with morphologically in 2014, WHO. They have a much more aggressiveness and show unusual metastatic patterns compared to usual type endocervical adenocarcinoma. They tend to present at higher stage and even in stage I, they have worse survival. Therefore, differential diagnosis of GAC from the usual type of endocervical adenocarcinoma is very important because they are related to a significant risk of recurrence and decreased 5-year disease-specific survival. Besides, GACs are mostly not associated with human papillomavirus (HPV) infection and p16 immunohistochemistry is also typically negative in GAC that is HPV-unassociated tumor. We report a very rare and interesting case of stage IB1 GAC with negative HPV DNA and p16.

Gastric-Type Extremely Well-Differentiated Adenocarcinoma of the Stomach: A Challenge for Preoperative Diagnosis

Gastric-type extremely well-differentiated adenocarcinoma (EWDA) is a rare type of gastric adenocarcinoma characterized by infiltration of well-formed mucinous glands with little or no nuclear atypia, which resemble foveolar epithelium or pyloric glands. Because of its high degree of differentiation, preoperative biopsy diagnosis of gastric-type EWDA is very difficult. We encountered a case of gastric-type EWDA, manifesting as a Borrmann type 4 lesion, in a 47-year-old man. Despite four repeated biopsies, the preoperative biopsy diagnosis was not conclusive due to the scarcity of diagnostic tumor cells and lack of knowledge regarding the unusual histologic findings of gastric-type EWDA. We herein describe the histologic findings of gastric-type EWDA in detail, with the aim of facilitating a preoperative biopsy diagnosis and understanding of this rare type of gastric adenocarcinoma.

A Case of Pyloric Gland Adenoma in the Cardia of the Stomach, Treated by Endoscopic Submucosal Dissection / 대한내과학회지

Pyloric gland adenoma is a recently described neoplasia that is very rare. It was first classified as a gastric tumor in 1990. Pyloric gland adenomas occur predominantly in old age, more frequently in women than in men, and they are often found in patients suffering from autoimmune gastritis. The diagnosis can be confirmed by immunohistochemistry, which is strongly positive for MUC6 and MUC5AC, expressed in the superficial layer. A pyloric gland adenoma is a type of gastric tumor, but it has also been reported in the gallbladder, pancreatic duct, duodenum, cervix of the uterus, rectum, and Barrett's esophagus. In 30% of gastric pyloric adenomas, transition to well-differentiated adenocarcinoma has been noted. Therefore, these lesionsshould be removed. In our case, the lesion was removed by endoscopic submucosal dissection. We report a case of pyloric gland adenoma in the cardia of the stomach showing typical endoscopic and microscopic features. This is the first case of pyloric gland adenoma of the stomach reported in Korea.