Villoglandular papillary adenocarcinoma (H&E)

Topic Completed: 1 September 2015

Revised: 28 December 2018, last major update September 2015

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Villoglandular papillary adenocarcinoma [title] cervix

Branko Perunovic D.M.
Ashwyna Sunassee, M.D.
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Cite this page: Perunovic, B., Sunassee, A. Villoglandular papillary adenocarcinoma (H&E). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixvilloglandularca.html. Accessed August 24th, 2019.
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)
  • Often in women age 40 years or less
Clinical features
Radiology images
Prognostic factors
  • Lower rate of ovarian metastasis compared to common forms of cervical cancer (Zhonghua Yi Xue Za Zhi 2015;95:519)
  • Case reports
    Gross description
    • Exophytic polypoid lesion
    Microscopic (histologic) 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)
    Microscopic (histologic) images

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    Tumor extends throughout most of cervix

    Papillary fibrovascular cores lined by mildly atypical epithelium

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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

    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
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