Villoglandular papillary adenocarcinoma

Author: Ashwyna Sunassee, M.D. (see Authors page)
Editor: Ryan Askeland, M.D.

Revised: 24 September 2015, last major update September 2015

Copyright: (c) 2003-2015, PathologyOutlines.com, Inc.

PubMed Search: Villoglandular papillary adenocarcinoma [title] cervix
Definition / General
  • Rare
  • Villoglandular papillary adenocarcinoma (VGA) of the cervix involves papillae lined by different types of epithelial cells that are histologically subclassified into endocervical, endometrioid, or intestinal subtypes
  • VGA's may be underdiagnosed as benign lesions by cytology because of their minimal cytologic atypia (Korean J Pathol 2012;46:215)
  • Excellent prognosis only if pure; must examine carefully for squamous differentiation or other growth patterns (Eur J Obstet Gynecol Reprod Biol 1999;87:183); limit diagnosis to cases with minimal atypia and no other types of carcinoma
  • Lower rate of ovarian metastasis compared to common forms of cervical cancer (Zhonghua Yi Xue Za Zhi 2015;95:519)
  • Often in women age 40 years or less
  • Pathophysiology
    Clinical Features
  • Post coital bleeding
  • Abnormal vaginal bleeding (Zhonghua Yi Xue Za Zhi 2015;95:519)
  • Radiology
  • MRI: Fern-leaf like appearance on high resolution T2-weighted images (Magn Reson Med Sci 2014;13:267)
  • Prognostic Factors
  • Excellent prognosis of VPGA overall compared to the common forms of cervical cancer (Int J Gynecol Cancer 2013;23:900)
  • Recurrences have been observed in patients with:
  • Presence of lymphatic invasion and deep stromal involvement appear to be risk factors for lymph node metastasis (J Med Assoc Thai 2001;84:882)
  • Case Reports
  • 22 year old woman with VGA of the uterine cervix with aggressive clinical course (Coll Antropol 2010;34:291)
  • 28 year old woman with VGA while pregnant (Tohoku J Exp Med 2004;202:305)
  • 28 year old woman with VGA diagnosed during early pregnancy (Case Rep Med 2010;2010:314547)
  • 29 year old woman with villoglandular papillary adenocarcinoma of the cervix with vaginal skip metastasis (Gynecol Oncol Case Rep 2011;1:1)
  • Clinicopathologic features of villoglandular papillary adenocarcinoma of the uterine cervix (Gynecol Oncol 2004;92:64)
  • Villoglandular papillary adenocarcinoma of the uterine cervix diagnosed during pregnancy (Eur J Gynaecol Oncol 2010;31:573)
  • Treatment
  • Depends on extent of invasion
  • Options include:
  • Gross Description
  • Exophytic polypoid lesion
  • Micro Description
  • Very well differentiated papillary adenocarcinoma
  • Surface papillae ranging from tall and thin to short and broad with fibrovascular cores typically containing numerous inflammatory cells
  • Papillae are lined by stratified epithelial cells with slight to moderate nuclear atypicality and mitotic activity
  • Epithelial lining may be endocervical, endometrial or intestinal type
  • Deeper portions of the tumor are composed of branching tubular glands separated by a fibrous or fibromatous stroma, sharply demarcated from adjacent cervical stroma (Cancer 1989;63:1773, Int J Gynecol Pathol 1993;12:1, Korean J Pathol 2012;46:215)
  • Micro Images
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    Tumor consists of villous projections

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    Mildly atypical columnar cells

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    Cervical loop specimen

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    Villoglandular pattern

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    Tumor throughout most of cervix

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    Papillary fibrovascular cores lined by mildly atypical epithelium

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    Adjacent area of higher grade adenocarcinoma

    Cytology Description
  • Hypercellular smears with smooth bordered three dimensional papillary fragments and relatively clean background
  • Minimal nuclear anisonucleosis
  • Fine granular chromatin with no / inconspicuous nucleoli
  • Nuclear overlap and crowding with nuclear membrane irregularity
  • Palisading columnar or spindle shaped cells with apical or elongated nuclei
  • Endocervical type: small but clear nucleoli
  • Endometrioid type: cohesive sheets of tumor cells with smooth edges and very round nuclei (lack of feathery edge)
  • Intestinal type: prominent tumor cells with abundant cytoplasmic mucin (Acta Cytol 2013;57:61, Korean J Pathol 2012;46:215, Diagn Cytopathol 2002;26:10, Cancer 1999;87:5)
  • Cytology Images
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    3D papillary tissue fragment

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    Long fronds

    Positive Stains
    Differential Diagnosis
  • Hyperplastic and reactive glands: no invasion, cells not cytologically malignant
  • Implant from endometrial tumor: see Int J Gynecol Cancer 2002;12:308
  • Other papillary carcinomas: smaller and thinner papillae, form a more complex lattice