Pathologic Description of Pap Smears & Biopsies in Gastric Type/Minimal Deviation Endocervical Adenocarcinomas
Elizabeth Morency, Takako Kiyokawa, Carlie S Sigel, Kay J Park. Memorial Sloan-Kettering Cancer Center, New York, NY; Chiba University, Chiba, Japan
Background: Gastric type (GT) mucinous endocervical adenocarcinoma (AD) is an aggressive tumor not associated with human papillomavirus (HPV) infection. It represents a spectrum of mucinous AD of the uterine cervix, including minimal deviation adenocarcinoma (MDA), and characteristically shows cells with voluminous, clear to amphophilic cytoplasm and distinct cell borders. They can be difficult to diagnose accurately on pre-resection biopsy and/or cytology due to their tendency to be well-differentiated histologically, which can lead to delayed treatment. Thus, our goal was to examine cytology (CY), biopsy (BX) and curettage (CU) specimens in cases of GT/MDA and describe the cytomorphologic features.
Design: The CY, BX and CU specimens from patients with resected GT/MDA were reviewed from two institutions. All available slides were reviewed and a detailed morphological analysis was performed.
Results: Ten cases were identified (9 GT, 1 MDA), all patients with CY (9 cervical ThinPrep® Papanicolaou stains, 1 pelvic fluid cytospin Pap stain), 2 with concurrent BX, and one with concurrent CU; with the following diagnoses: AD (6 cervical Paps, 2 BX), suspicious for AD (2 cervical Paps, 1 pelvic fluid, 1 CU), atypical glands of undetermined significance (AGUS) (1 cervical Pap). Cases called AD or suspicious on CY (all GT) displayed anisonucleosis, prominent nucleoli, fine chromatin, dense nuclear membranes and abundant foamy cytoplasm. Cells were columnar or round and in cohesive, crowded 3-D clusters and/or disorganized sheets with occasional naked nuclei. Three of 8 cases had a tumor diathesis. The case of AGUS (MDA) was similar but had scant tumor cellularity and a clean background. The 2 cervical BXs showed infiltrative glands, some with cytoplasmic mucin. Signet ring cells were apparent in one case. Nuclei ranged from small and hyperchromatic to large with prominent nucleoli. One case showed abundant dense eosinophilic cytoplasmic globules. Mitoses and apoptoses were not apparent. The atypical CU specimen (MDA) showed strips of mucinous cells with small bland nuclei with abundant apical mucin, as well as markedly enlarged nuclei with prominent nucleoli and irregular nuclear contours.
Conclusions: The features of GT/MDA on CY often show clusters of cells with prominent nucleoli and abundant foamy cytoplasm. BX and CU can be slightly more difficult, especially in MDA, but careful evaluation of key cytomorphologic features including the cytoplasmic quality and presence of prominent nucleoli can aid in making a timely and accurate diagnosis.
Monday, March 4, 2013 1:00 PM
Poster Session II # 80, Monday Afternoon