Cervix
Carcinoma
Adenoid cystic carcinoma

Author: Carlos Parra-Herran, M.D. (see Authors page)

Revised: 16 August 2017, last major update April 2017

Copyright: (c) 2007-2017, PathologyOutlines.com, Inc.

PubMed Search: Adenoid cystic carcinoma cervix

Cite this page: Parra-Herran, C. Adenoid cystic carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixadenoidcystic.html. Accessed December 18th, 2017.
Definition / general
  • Uncommon (less than 1% of primary cervical adenocarcinomas), occurs in elderly, black women with multiple pregnancies
  • Recently characterized by Xing et al, who divide adenoid cystic carcinomas of the lower female genital tract (cervix and vulva) in two distinct groups (Am J Surg Pathol 2016;40:529):

Pure adenoid cystic carcinoma Mixed carcinoma with adenoid cystic differentiation
Patient age Median 48 years, range 27 - 74 Median 76 years, range 50 - 86
Adenoid cystic component 100% Usually < 25%
High risk HPV Not detected Detected (usually HPV16)
p16 immunohistochemistry Nondiffuse Diffuse and strong
Perineural invasion ~50% Absent

  • Poor prognosis due to frequent local recurrences and distant metastases in approximately 50% of cases (Am J Surg Pathol 1988;12:134)
  • Adenoid cystic carcinoma may be a component of a mixed malignant lesion; commonly admixed with squamous cell carcinoma, adenoid basal carcinoma and even carcinosarcoma (Am J Surg Pathol 2001;25:338)
Case reports
Treatment
  • Surgery is the primary form of treatment, if early stage
    • Complete excision is required to exclude the possibility of a second component (squamous cell or adenoid basal carcinomas)
  • Radiotherapy and chemotherapy in elderly or advanced stage
Gross description
  • Irregular, polypoid, friable cervical mass
Gross images

Images hosted on PathOut server:

Contributed by Dr. Ihab Hosny, Ohio

Microscopic (histologic) description
  • Adenoid cystic carcinoma of the uterine cervix displays the same morphologic features of its counterparts in the salivary gland, larynx / trachea / lung, breast and vulva
  • The tumor is composed of basaloid cells arranged in cribriform, tubular and solid growth patterns
  • Tumors with cribriform architecture have cystic areas containing mucinous or eosinophilic secretions, alternating with pseudocystic areas containing basement membrane-like material [positive for collage type IV and periodic acid-Schiff (PAS) stain] (Am J Surg Pathol 1999;23:448)
  • Tumors with solid growth also have basement membrane-like material around tumor nests and cords (IInt J Gynecol Pathol 1992;11:2)
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Carlos Parra-Herran, M.D.

Cribriform architecture and basement membrane material



Contributed by Dr. Ihab Hosny, Ohio:

Vascular invasion

Actin

CEA


EMA

High molecular weight keratin

S100




Images hosted on other servers:

Cribriform architecture
and basement membrane
material

Fig. 1: friable and ulcerated cervical mass
Fig. 2: cribriform islands of basaloid cells with peripheral palisading, high N/C ratio and scant mitotic activity
Fig. 3: focal solid pattern
Fig. 4: infiltrating cords of cells within basement membrane-like material


Virtual slides

Images hosted on other servers:

Adenoid cystic carcinoma

Cytology description
Cytology images

Images hosted on other servers:

Three dimensional structures

Positive stains
Electron microscopy description
Molecular / cytogenetics description
Differential diagnosis
  • Adenoid basal carcinoma: no intraluminal hyaline material, smaller and less pleomorphic nuclei, usually no type IV collagen or laminin (Am J Surg Pathol 1999;23:448)
    • Both lesions can coexist
    • Adenoid cystic carcinoma has more nuclear atypia, expansile growth pattern, distinct stromal reaction and necrosis; mitotic figures, angiolymphatic invasion and hyalinized stroma are common
Additional references