Cervix
Adenocarcinoma
Microinvasive adenocarcinoma
Authors: Ashwyna Sunassee, M.D., Ryan W. Askeland, M.D.
Topic Completed: 1 March 2016
Minor changes: 26 February 2020
Copyright: 2003-2020, PathologyOutlines.com, Inc.
PubMed Search: Microinvasive adenocarcinoma [title] cervix
Table of Contents
Definition / general | Essential features | Epidemiology | Pathophysiology | Clinical features | Prognostic factors | Case reports | Treatment | Microscopic (histologic) description | Cytology description | Positive stains | Differential diagnosis | Additional referencesCite this page: Sunassee A, Askeland R. Microinvasive adenocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixmicroinvasiveadeno.html. Accessed August 6th, 2020.
Definition / general
- Also called early invasive adenocarcinoma
- Adenocarcinoma with depth of invasion of no greater than 5 mm and a horizontal dimension of no greater than 7 mm (Aust N Z J Obstet Gynaecol 1999;39:411)
- Characterized by minimal stromal invasion
- Cytology is 30% sensitive for identification of stromal microinvasion (Diagn Cytopathol 1997;16:430)
- Often coexisting squamous intraepithelial neoplasia (Aust N Z J Obstet Gynaecol 1999;39:411)
Essential features
- Tumors less than 7 mm width or 5 mm in thickness
- Excellent prognosis (Obstet Gynecol 2001;97:701)
- Often coexistent squamous intraepithelial lesion (SILs) (Aust N Z J Obstet Gynaecol 1999;39:411)
- Associated with minimal metastases to nodes (Int J Gynecol Cancer 2004;14:104)
Epidemiology
- ~12% of all microinvasive cervical carcinoma (Int J Gynecol Pathol 2000;19:29)
- An increased number of microcarcinomas are diagnosed in young women in childbearing age, which coincides with the most common period for the onset of preneoplastic cervical lesions (Cancer 2010;116:2343)
Pathophysiology
- Associated with HPV (Int J Cancer 2016;138:409, Open Virol J 2012;6:232)
Clinical features
- Often asymptomatic (atypical glandular cells on Pap test)
Prognostic factors
- Endocervical "usual type" associated with better prognosis
- Endometrioid or clear cell histology may be associated with late recurrence and worse survival in stage 1A1 and 1A2 MIAC. (Gynecol Oncol 2011;121:135)
Case reports
- 23 year old woman with HPV vaccination and microinvasive adenocarcinoma (J Low Genit Tract Dis 2014;18:E50)
- 30 year old woman with lethal endometrial recurrence after cone biopsy for microinvasive cervical adenocarcinoma (J Obstet Gynaecol Res 2008;34:413)
Treatment
- Conservative management, simple hysterectomy (Eur J Gynaecol Oncol 2013;34:296)
- Conization or cone biopsy may be considered for women strongly desiring to preserve fertility and accepting the risk of recurrent disease (J Low Genit Tract Dis 2012;16:381, Am J Obstet Gynecol 2012;206:80)
Microscopic (histologic) description
- Endocervical "usual type": most common histology, arising close to squamous-columnar junction in more than 90% of cases
- Endometrioid and clear cell types may arise in any place along the cervical canal (Gynecol Oncol 2011;121:135)
- Up to 5 mm of invasive disease as measured from surface
- Budding of cells from adenocarcinoma in situ gland
- Vesicular nuclei with prominent nucleoli
- Desmoplastic stroma
- Glands deeper than normal endocervical glands or invasive growth pattern
- Pathologic staging:
- pT1a1: Stromal invasion ≤3.0 mm in depth and horizontal spread ≤7.0 mm
- pT1a2: Stromal invasion >3.0 mm but not more than 5.0 mm in depth and horizontal spread ≤7.0 mm
Cytology description
- Atypical glandular cells forming pseudosyncytial clusters (Gynecol Oncol 1999;73:292)
- Crowded sheets with enlarged, round and irregular shaped nuclei, prominent oval nucleoli (Acta Cytol 1991;35:109)
- Cell detritus is considered highly specific for invasion but lacks sensitivity (Diagn Cytopathol 1997;16:430)
- Glandular dyskaryosis (Eur J Obstet Gynecol Reprod Biol 2003;108:209)
Positive stains
- CD44 may be positive in the stroma surrounding invasive glands (Arkh Patol 2012;74:28)
- CEA, keratin (50%)
Differential diagnosis
Additional references
