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Uterus

Carcinoma

Minimal deviation adenocarcinoma

 

Reviewer: Mohamed Mokhtar Desouki, MD, PhD, Medical University of South Carolina

Revised: 17 November 2014, last major update June 2010

Copyright: (c) 2002-2014, PathologyOutlines.com, Inc.

 

Definition

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Low grade (well differentiated), diffuse, infiltrative endometrioid adenocarcinoma with no / minimal stromal reaction

Not a WHO diagnosis

See also Cervix chapter

 

Terminology

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Diffusely infiltrating endometrial adenocarcinoma (Am J Surg Pathol 1999;23:69)

Adenoma malignum of the uterine corpus

 

Epidemiology

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● Age range 46-68 years (Histopathology 2003;42:77)

 

Sites

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Body of the uterus or isthmus (Gynecol Oncol 1995;58:136), with or without cervical involvement

 

Etiology

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Unknown, but considered a differentiated state of typical endometrioid adenocarcinoma

Associated with typical endometrioid adenocarcinoma in most cases (Am J Surg Pathol 1988;12:754)

Pure tumors also reported (Arch Pathol Lab Med 1995;119;751, Am J Surg Pathol 1993;17;660-cervix)

 

Clinical features

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No history of hormonal replacement therapy in most cases.

● May invade cervix (Histopathology 2003;42:77)

 

Case reports

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● 45 year old woman with involvement of corpus (focal), isthmus and entire cervix (Hum Pathol 2002;33:856)

● 56 year old woman with minimal deviation mucinous adenocarcinoma ('adenoma malignum') (Pathol Int 2010;60:42)

 

Treatment

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● Similar to conventional endometrioid adenocarcinoma

 

Gross description (Macroscopy)

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● Usually no gross tumor, area of involvement may be unusually firm (Histopathology 2003;42:77)

 

Gross images

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Images: cervix is firm, but otherwise unremarkable

 

Micro description (Histopathology)

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● Simple glandular growth pattern with infrequent branching

● Scattered, deeply infiltrative glands with mild cellular and nuclear atypia and rare mitotic figures

● Tumor cells grow along fibrovascular tissue, especially in perivascular spaces

● Minimal to absent stromal desmoplasia

● Typical endometrioid adenocarcinoma, when present, is usually more superficial, and separated by a transitional area with mildly atypical glands that appear to arise from adenocarcinoma component

● FIGO grade 1 and nuclear grade 1 (Histopathology 2003;42:77)

● Careful examination required to correctly assess tumor depth and stage

 

Micro images

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Figure 6A/6B

 

 

  

Cervical tumors

 

Cytology description

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● May have squamous metaplasia, epithelial cells incorporating neutrophils (Diagn Cytopathol 1999;21:117)

 

Cervix (adenoma malignum): irregular sheets of benign looking glandular cells with occasional clearing of cytoplasm, wispy cytoplasmic extensions or tails; slightly enlarged nuclei, conspicuous nucleoli; may have clusters of atypical glandular cells with prominent nucleoli (Diagn Cytopathol 1995;13:146)

 

Cytologic differential diagnosis includes:

● Clear cell carcinoma

● Microglandular hyperplasia

● Diffuse laminar glandular hyperplasia

● Tubal metaplasia

● Well-differentiated invasive or in situ adenocarcinoma

 

Positive stains

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ER, PR, CK7

● Also vimentin (Histopathology 2003;42:77)

 

Negative stains

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CK20, CEA, p53, MIB1 (near zero)

 

Differential Diagnosis

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Adenomyosis: numerous small cysts in enlarged and globular uterus, associated with myometrial hypertrophy and trabeculated smooth muscle; no typical adenocarcinoma, no infiltration, no atypia, no mitotic figures

 

End of Uterus > Carcinoma > Minimal deviation adenocarcinoma

 

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