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Uterus
Carcinoma
Minimal deviation adenocarcinoma
Reviewer: Mohamed Mokhtar Desouki, MD, PhD, Medical University of South Carolina
Revised: 21 September 2012, last major update June 2010
Copyright: (c) 2002-2012, 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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