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Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosisCite this page: Minimal deviation adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusminimaldev.html. Accessed July 16th, 2017.
Definition / general
- Low grade (well differentiated), diffuse, infiltrative endometrioid adenocarcinoma with no / minimal stromal reaction
- Not a WHO diagnosis
- See also Cervix chapter
Terminology
- Diffusely infiltrating endometrial adenocarcinoma (Am J Surg Pathol 1999;23:69)
- Adenoma malignum of the uterine corpus
Epidemiology
- Age range 46 - 68 years (Histopathology 2003;42:77)
Sites
- Body of the uterus or isthmus (Gynecol Oncol 1995;58:136), with or without cervical involvement
Etiology
- 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)
Clinical features
- No history of hormonal replacement therapy in most cases.
- May invade cervix (Histopathology 2003;42:77)
Case reports
- 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
- Similar to conventional endometrioid adenocarcinoma
Gross description
- Usually no gross tumor, area of involvement may be unusually firm (Histopathology 2003;42:77)
Gross images
Images hosted on other servers:
Cervix is firm, but otherwise unremarkable
Microscopic (histologic) description
- 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
Microscopic (histologic) images
Images hosted on other servers:
Figure 6A / 6B
Cervical tumors
Cytology description
- 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
- ER, PR, CK7
- Also vimentin (Histopathology 2003;42:77)
Differential diagnosis
- 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
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