Primary Cervical Carcinoma with Secondary Adnexal and Uterine Corpus Involvement: Detailed Morphologic Analysis of 14 Cases
Kay J Park, Rajmohan Murali, Carolina Reyes. Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Cervical adenocarcinomas (AdCa) and squamous cell carcinomas (SCC) uncommonly metastasize to adnexa or involve uterine corpus. Metastatic cervical AdCa to ovaries may be difficult to distinguish from primary ovarian endometrioid or mucinous tumors. We analyzed the morphology of adnexal and/or uterine corpus involvement by cervical AdCa and SCC.
Design: Patients with cervical SCC and human papillomavirus-associated AdCa who underwent surgery at MSKCC from 1997-2012 were identified. The following features were recorded in cases involving adnexa or uterine corpus: clinically visible lesion; depth of invasion; lymphovascular invasion (LVI); pattern of corpus and/or adnexal involvement (colonizing pre-existing epithelium, nodular vs infiltrating, bilaterality, presence of surface ovarian nodules and size of ovaries).
Results: Of 538 patients with invasive cervical cancer, 14 involved the adnexa and/or uterine corpus (SCC= 8; AdCa= 6). 11 had visible masses (6 SCC, 5 AdCa) and all had deep cervical invasion with LVI. 10 involved the corpus (6 SCC, 4 AdCa) all colonizing endometrial epithelium and 8 invading the myometrium, mostly deep/diffuse. 5 of 8 SCC had ovarian metastases (ovarian size from 2cm to 8cm): bilateral with surface involvement (n=1), unilateral with nodular and/or diffuse parenchymal tumors (n=4). Five had fallopian tube (FT) involvement (4 also involving ovary, 1 bilateral) with nodules of SCC around the FT (n=3) and SCC colonizing FT epithelium (n=2). Two of 6 AdCA had unilateral ovarian metastases (ovarian sizes 2.6cm and 4.0cm). One with a nodule of AdCa on the surface, and the other with papillary and cribriform glands with confluent growth, simulating primary ovarian endometrioid carcinoma. 4 had FT involvement (including those with ovarian metastasis), all with AdCa colonizing normal FT mucosa mimicking primary endometrioid adenocarcinoma and even serous tubal intraepithelial carcinoma. They contained elongated nuclei, apical mitoses and apoptotic bodies, typical of usual endocervical AdCa.
Conclusions: Adnexal involvement by cervical carcinoma is rare. Most of our cases had concurrent endometrial and deep myometrial extension of the cervical carcinoma. Both SCC and AdCa may colonize tubal and endometrial mucosa, and adenocarcinoma in particular may mimic an ovarian primary. Bilaterality is not a common feature of metastatic endocervical adenocarcinoma. Awareness of these features and clinico-pathologic correlation is important for accurate diagnosis.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 230, Tuesday Afternoon