Gastric-Type Endocervical Adenocarcinoma – An Aggressive Histologic Subtype
Yevgeniy Karamurzin, Vinita Parkash, Takako Kiyokawa, Robert A Soslow, Kay J Park. Memorial Sloan-Kettering Cancer Center, New York, NY; Yale University School of Medicine, New Haven, CT; Chiba University School of Medicine, Chiba, Japan
Background: Gastric type adenocarcinoma (GA), including minimal deviation adenocarcinoma (MDA), is a rare variant of endocervical adenocarcinoma (ECA) that is not etiologically associated with human papillomavirus (HPV). GA and MDA represent morphologic spectrums of the same tumor and have been reported to have a worse prognosis than usual HPV-associated ECA. We describe the clinical outcomes and distribution patterns of metastases in a series of GA/MDA.
Design: A retrospective review of GA or MDA was performed from the pathology databases of two institutions, spanning 14 years. Stage at diagnosis (DX), recurrence/metastases patterns and overall survival were analyzed.
Results: 31 cases were identified, 29 of which had follow-up data. The patients ranged in age from 30 to 66 years (mean 50). One patient had a family history of Li-Fraumeni syndrome, while one had Peutz-Jeghers syndrome. The stages at presentation were as follows: IA1 (1), IA2 (1), IB1 (9), IIA1 (2), IIA2 (3), IIB (1), IIIB (8), IVB (6). More than half the patients presented at advanced stage IIA-IVB (65%). At the time of diagnosis, 8/17 patients (47%) had positive lymph nodes (LNS), 8/23 (35%) had adnexal (AD) metastases (MET) and 12/26 (46%) had pelvic and/or abdominal disease, of which 7 had concurrent AD or LN involvement. 17/27 (63%) had at least one site of MET at DX. MET sites included LNS, adnexa, omentum, bowel, peritoneum, diaphragm, abdominal wall, bladder, vagina and appendix. All patients were treated with radical surgery, chemoradiation or a combination. Follow-up ranged from 1 to 89 months (MOS) (mean 24); 14 (48%) have no evidence of disease, 4 (14%) are alive with disease, and 11 (38%) died of disease. Survival ranged from 2 to 89 MOS (mean 30). Ten patients (33%) recurred between 6-70 MOS (mean 20) involving retroperitoneal and inguinal LNS, liver, lung, vagina, bladder, colon, pelvis, omentum, brain, bone and appendix.
Conclusions: GA represents a distinct, biologically aggressive type of cervical adenocarcinoma. The majority of patients present at advanced stage (65% >=stage II), intraabdominal and pelvic MET are not uncommon and the disease carries a high mortality rate (38%). The rate and sites of metastases and recurrence are unusual for cervical ACA and may require a different clinical approach from usual ECA.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:15 PM
Platform Session: Section B, Tuesday Afternoon