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Uterus (excludes Cervix)
Epithelial tumors
Villoglandular carcinoma
Reviewer: Mohamed Mokhtar Desouki, MD, PhD, Medical University of South Carolina (see Reviewers page)
Revised: 22 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.
Definition
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● Rare variant of well-differentiated, endometrioid adenocarcinoma
Terminology
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● Also called villoglandular endometrioid carcinoma (VGEC)
Clinical features
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● Most patients present after menopause with vaginal bleeding
● 40% of tumors are pure VGEC, and the rest are mixed with typical endometrioid carcinoma foci
● Similar behavior as mixed villoglandular / endometrioid carcinomas of similar grade (Am J Surg Pathol 1998;22:1379)
● Myoinvasion predicts vascular invasion and nodal involvement
● Villoglandular tumors with myometrial invasion may have poorer prognosis than nonvilloglandular tumors with myometrial invasion (Am J Surg Pathol 1994;18:569)
Treatment
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● Similar to conventional endometrioid adenocarcinoma: total abdominal hysterectomy with pre- and postoperative radiation
Gross description
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● Visible tumors vary from sessile, fungating masses that fill the uterine cavity to nodules or irregular, thickened plaques that may be localized or diffuse
Micro description
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● Dominant pattern is well-differentiated, papillary structures
● Cells resemble classic, glandular endometrioid pattern with uniform columnar cells and bland nuclei perpendicular to basement membrane
● Thin and simple papillary structures without broad, fibrovascular cores
● Squamous differentiation may be present, but bland without atypia
● Note: biopsy diagnosis is often inaccurate (Acta Obstet Gynecol Scand 2009;88:355)
Micro images
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Various images
Fig 69: The tumor cells are well-differentiated, but grow in a papillary pattern rather than a glandular pattern
Fig 70: Low magnification shows the growth pattern of this tumor
Fig 71: This case also illustrates the villoglandular architecture. See fig 72 for cellular detail (fig 71 and 72 are from the same patient)
Fig 72: Higher magnification of fig 71 shows typical features of serous papillary adenocarcinomas: relatively uniform nuclei, marked cellular stratification, cellular buds, exfoliation of groups of cells into lumina, no/rare mitotic activity
Positive stains
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● Pancytokeratin, EMA, CA125, ER/PR (+++), vimentin, Ber-EP4, B72.3, CK7
● p53 (minority of cases), beta-catenin (nuclear and cytoplasmic), p16 (occasionally)
Negative stains
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● CK20, CDX2, CEA, PTEN
Differential Diagnosis
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● Serous, mucinous, clear cell and transitional carcinomas
● Non-neoplastic, papillary proliferations with fibrous cores, lined by metaplastic cells
● Syncytial changes
● Arias-Stella reaction
Additional references
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End of Uterus > Epithelial tumors > Villoglandular carcinoma
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