Immunohistochemical study of carcinoembryonic antigen of the tissue and cell levels in adenocarcinoma of the uterus

Immunohistochemical staining was performed for carcinoembryonic antigen (CEA) in tissues taken from 41 cases of cervical and 67 cases of endometrial adenocarcinomas. Utilizing this method, smear specimens from 21 cases with cervical and 25 cases with endometrial adenocarcinomas were investigated at the cell level. The results: 1) The investigation at the tissue level indicated that CEA staining was positive in 80% of cases of cervical adenocarcinoma. On the other hand, the positive rate was as low as 55% of the endometrial adenocarcinoma cases. It further declined to 35% when limited to pure adenocarcinoma without squamous elements. In addition, a difference was recognized between the cervical and endometrial groups in their localization. It was apparent that while even the cytoplasm in most of the cervical adenocarcinoma appeared to be markedly stained, such a tendency was observed and was weak in only a part of the cell membrane in the endometrial adenocarcinoma cases. 2) The studies with smear specimens indicated that while 57% (13/21) of the cervical adenocarcinoma cases were CEA positive, only 12% (3/25) were positive in endometrial adenocarcinoma cases. Therefore, a difference was recognized between the two at the cell level in their CEA staining characteristics. 3) Our observation revealed that CEA was more prominent in the poorly differentiated type than in the well differentiated one, in both cervical and endometrial adenocarcinoma. This seems to indicate a relationship between the histological differentiation and production of CEA. On the basis of the above findings, it was inferred that although both cervical and endometrial adenocarcinoma occur in the common Müllerian duct organ, they might have different biological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)     

A panel of immunohistochemical stains, including carcinoembryonic antigen, vimentin, and estrogen receptor, aids the distinction between primary endometrial and endocervical adenocarcinomas.

The histological distinction between a primary endometrial and a primary endocervical adenocarcinoma is often difficult, especially in small biopsy specimens. A preoperative distinction is important because primary surgical management differs between the two tumors. Cases of primary endometrioid endometrial (n=30) and primary endocervical (n=26) adenocarcinoma of endocervical type were stained immunohistochemically with the monoclonal antibodies against carcinoembryonic antigen (CEA), vimentin, estrogen receptor (ER), and 34 beta E12. In all cases the origin of the adenocarcinoma was confirmed by examination of the definitive pathology specimen. There was diffuse positive nuclear staining for ER in 28 of 30 (93%) endometrial adenocarcinomas. ER was negative in 16 of 26 endocervical adenocarcinomas, and there was focal weak nuclear staining in the other cases. Vimentin was positive in 29 of 30 (97%) endometrial adenocarcinomas but in only 2 of 26 (8%) endocervical adenocarcinomas. CEA was positive in 25 of 26 (96%) endocervical adenocarcinomas, mostly with diffuse membranous and cytoplasmic staining. Positivity with CEA was present in 21 of 30 (70%) endometrial adenocarcinomas but was largely confined to squamoid areas with only 12 tumors exhibiting focal membranous staining of the glandular component. 34 beta E12 was diffusely positive in all except one cervical adenocarcinoma. In endometrial carcinomas, positivity was strongest in squamoid areas but there was positive staining, either focally or diffusely, of the glandular component in 27 cases. In summary, primary endometrioid endometrial adenocarcinomas are characterized by diffuse, strong, positive staining for vimentin and ER and negative or very focal, positive staining of the glandular component for CEA. In contrast, primary endocervical adenocarcinomas are characterized by CEA positivity, which is usually but not always diffuse, negativity for vimentin, and negativity or focal weak positivity for ER. 34 beta E12 is of no value in the distinction between endometrial and endocervical adenocarcinomas. A panel of immunohistochemical stains, comprising CEA, vimentin, and ER, generally allows confident preoperative distinction between a primary endometrial and endocervical adenocarcinoma.     

Immunohistological study of isoantigens, carcinoembryonic antigen and human chorionic gonadotropin in adenocarcinomas of the uterus

Isoantigens, carcinoembryonic antigen (CEA) and human chorionic gonadotropin (hCG) were simultaneously studied by immunohistology in the cervical and endometrial adenocarcinomas. Isoantigen loss was observed in all adenocarcinoma in situ (AIS) of the uterus. However, they appeared again in some tumor cells in 8 of 23 cervical and 4 of 41 endometrial adenocarcinomas. CEA was positive in 1 of 4 AIS and 22 of 23 adenocarcinomas of the cervix. It was distributed continuously in the apical portion and/or in the whole cytoplasm of tumor cells. On the other hand, CEA was positive only in 16 of 41 endometrial adenocarcinomas. It was strongly positive in the squamous elements, but weakly and sparsely in the apical portion and/or in the cytoplasm of some isolated glandular cells which occasionally showed a tendency to squamous differentiation. The majority of neoplastic glands, however, were negative for CEA. HCG was positive in 1 of 23 cervical and 3 of 41 endometrial adenocarcinomas. Two or 3 antigens were found concomitantly in some tumors, but localized differently from each other. It was concluded from the present study that the simultaneous examination of multiple antigens may be useful for characterization of adenocarcinomas of the uterus.     

In situ adenocarcinoma and squamous carcinoma of uterine cervix. Pathological and immunohistochemical analysis with cytokeratin 13

OBJECTIVES: The aim of the study was the pathological and immunohistochemical analysis of cytokeratin 13 (CK13) in intraepithelial cervical tumors. STUDY DESIGN: We studied 415 in situ squamous carcinomas and 13 in situ mucinous cervical type adenocarcinomas of the uterine cervix. All patients underwent laser cervical conization and had a follow-up ranging 12-135 months. RESULTS: 3% of the squamous carcinoma patients recurred during the follow-up period, while the percentage of recurrence of in situ adenocarcinoma patients was 7.6%. We observed positive surgical edges in 46.1% of glandular tumors, and in 5% of squamous tumors. The percentage of recurrence was high among the cases with positive borders independently from their histopathologic type (14.3% in the squamous carcinomas versus 50% in the adenocarcinomas), compared to cases with negative edges (2.3% in the squamous carcinomas versus 0% in the adenocarcinomas). We observed CK13 positive staining in cervical squamous tumors and in mucinous cervical type adenocarcinomas, while there was no positive staining in non-neoplastic cervical glandular elements. CONCLUSION: CK13 positive immunostaining among in situ squamous and in situ mucinous cervical type adenocarcinoma cases adds additional evidence to data supporting a common origin of the two lesions.     

Carcinoembryonic antigen in primary and metastatic ovarian tumors

The immunoperoxidase method and an absorbed monospecific commercial rabbit anti-CEA antiserum were used to detect CEA in 105 primary ovarian tumors and 12 metastatic ovarian adenocarcinomas of intestinal origin. Primary ovarian tumors showed CEA in foci of squamous differentiation in 9 out of 10 cases of endometrioid carcinomas and focally in areas of intestinal differentiation in 21 out of 28 mucinous tumors as well as 4 out of 5 Brenner tumors. All of the serous tumors, clear cell carcinomas, and undifferentiated carcinomas as well as 19 of the 22 mucinous tumors without intestinal differentiation lacked CEA. All metastatic ovarian adenocarcinomas showed characteristic diffuse staining of CEA. Differences in CEA staining were found to be useful for histological differentiation between primary ovarian cancers and metastatic ovarian adenocarcinomas of intestinal origin. Furthermore, these data might be helpful in the selection of patients for serial CEA evaluation.     

Immunohistochemical characterization of endocervical papillary serous carcinoma

Abstract.   Nofech-Mozes S, Rasty G, Ismiil N, Covens A, Khalifa MA. Immunohistochemical characterization of endocervical papillary serous carcinoma. Int J Gynecol Cancer 2006; 16(Suppl. 1): 286–292.
Endocervical adenocarcinomas are rare and aggressive neoplasms. Papillary serous endocervical adenocarcinomas are the rarest form of endocervical adenocarcinomas. This tumor exhibits morphologic similarities to its counterparts commonly seen in the endometrium, fallopian tubes, ovaries, and peritoneum, which are known to have an aggressive behavior. Because of the rarity of this tumor, little is known about its immunophenotyping. In this study, we included ten cases of papillary serous carcinomas arising from the uterine cervix (PSCC) diagnosed in the absence of a primary endometrial malignancy. We studied their immunohistochemical profile, using a panel of antibodies against Ki67, bcl-2, p53, carcinoembryonic antigen (CEA), and CD10, and compared them to 20 consecutive cases of cervical adenocarcinoma of conventional cell subtypes (CAC) (15 mucinous, 3 adenosquamous, and 2 endometrioid). Immunostaining was recorded semiquantitatively. Patients with PSCC ranged in age from 27 to 79 years (mean = 51.6 ± 19.1), while the conventional cell subtypes control group were 28–90 years old (mean = 47.5 ± 16.9). Only p53 and CEA immunostaining significantly correlated with the PSCC morphology ( P = 0.001 and P = 0.016, respectively) as shown by Cochran–Mantel–Haenszel Statistics (Modified Ridit Scores). PSCC is a distinctive immunophenotypic subtype of endocervical adenocarcinoma with significantly higher p53 and lower CEA reactivity than other more common histologic subtypes.     

Adenocarcinoma of the endometrium: Analysis of 256 cases with carcinoma limited to the uterine corpus: Pathology review and analysis of prognostic variables

Histologic specimens of all patients undergoing hysterectomy for clinical Stage I adenocarcinoma of the endometrium at Stanford University Hospital between 1959 and 1975 were reexamined. From this group 256 acceptable cases of adenocarcinoma confined to the uterine corpus (Pathologic Stage I) were identified. In patients treated with initial surgery, relapse rate was highly correlated with depth of myometrial invasion (P = 0.0001) and also with the histologic grade of the uterine adenocarcinoma (P = 0.008). Twenty-six patients (10%) had lesions with papillary architecture and anaplastic cytology similar to papillary serous carcinoma of the ovary. These women with uterine papillary serous carcinoma (UPSC) had a 50% relapse rate and accounted for one-half the treatment failures ( ) in the entire study group. Six of the seven upper abdominal relapses in this study were in patients with UPSC, suggesting that this histologic variant may behave more like ovarian serous carcinoma than the usual endometrial adenocarcinoma. Twenty-one patients (9%) had endometrial carcinomas with extensive mucinous differentiation (mucinous carcinoma), while 38% of all the cases of endometrial carcinoma showed at least some focal mucin production. Twenty percent showed focal squamous differentiation. Neither mucinous nor squamous differentiation, as we have applied these designations, were significantly correlated with relapse rate. Among the patients undergoing hysterectomy for clinical Stage I adenocarcinoma, 99 patients were found on review to have lesions which fell short of our current criteria for diagnosis of carcinoma in the uterine corpus and were reinterpreted as metaplasia and/or hyperplasia. None of these patients subsequently developed clinical relapse. The results of this study suggest a need for modification in the FIGO grading system for endometrial cancer and also support a definition of well-differentiated endometrial carcinoma more restrictive than that commonly employed.     

Pathological study of endometrial carcinogenesis in androgen-sterilized-rats

As reported previously, squamous metaplasias, endometrial hyperplasias and cancers of the uterus occurred more frequently in androgen-sterilized-rats (ASR) than in normal rats (NR). This time we pathologically examined the endometrium of ASP in detail and obtained the following results: 1) In NR, aged from 70 to 750 days, no abnormal findings were found. In 61 ASR, aged more than 500 days, were found 8 simple endometrial hyperplasias, 2 atypical endometrial hyperplasias, 15 simple squamous metaplasias, 1 atypical squamous metaplasia, 2 adenocarcinomas, 1 adenosquamous carcinoma and 1 squamous carcinoma. 2) In ASR, proliferative and metaplastic changes coexisted in the endometrium. Two adenocarcinomas were accompanied by metaplasias and atypical hyperplasias, and one squamous carcinoma was accompanied by simple hyperplasias. 3) The endometrial carcinogenesis of ASR was thought to be as follows. In ASR, the endometrial epithelium loses its secretory function, becoming low columnar epithelium. A part of the non-secretory endometrium gains proliferative activity and progresses to metaplastic epithelium or to glandular hyperplasia. The former may develop to atypical metaplasia and squamous carcinoma, the latter to atypical hyperplasia and adenocarcinoma.     

Intestinal-type cervical adenocarcinoma in situ and adenocarcinoma exhibit a partial enteric immunophenotype with consistent expression of CDX2.

Most cases of cervical adenocarcinoma in situ (AIS) and adenocarcinoma are of the usual or endocervical type. However, intestinal types of AIS and adenocarcinoma exist. With an intestinal-type adenocarcinoma in the cervix, the question may arise as to whether one is dealing with a primary cervical neoplasm or direct or secondary spread from an intestinal adenocarcinoma. In organs such as the ovary, urinary bladder, esophagus, and gallbladder, intestinal-type glandular epithelium often expresses enteric markers, but this has hardly been studied in the cervix. The purpose of this study was to investigate whether intestinal-type AIS and adenocarcinoma in the cervix express enteric markers and to ascertain whether these antibodies are of value in the distinction from a metastatic intestinal adenocarcinoma. We compared the immunophenotype of these lesions with that of usual-type AIS and adenocarcinomain the cervix. Cases included were AIS of usual type (n = 6), primary cervical adenocarcinoma of usual type (n = 6), AIS of intestinal type (n = 21), primary cervical adenocarcinoma of intestinal type (n = 3), primary cervical adenocarcinoma with signet ring cells (n = 2), and colorectal adenocarcinoma involving the cervix (n = 5). All cases were stained with cytokeratin (CK) 7, CK20, monoclonal carcinoembryonic antigen (CEA), p16, and CDX2. Staining was categorized as negative, focally positive (<50% cells), or diffusely positive (50% or more cells). Usual-type AIS was always diffusely CK7 positive, typically diffusely CEA and p16 positive, and always CK20 negative. CDX2 was positive in 1 case. All usual cervical adenocarcinomas were diffusely CK7 and p16 positive, and all were immunoreactive with CEA. Five and 2 cases were CK20 and CDX2 positive, respectively. Intestinal-type AIS was diffusely CK7 positive (all cases) and typically CK20 negative and diffusely CEA and p16 positive. All but 1 case exhibited diffuse nuclear positivity with CDX2. In addition, usual-type AIS adjacent to intestinal type was CDX2 positive in 13 of 21 cases. The 3 cases of primary cervical intestinal-type adenocarcinoma were diffusely CK7 positive, focally or diffusely positive with CK20 and CDX2, and focally positive with CEA. One case was diffusely p16 positive, 1 focal and 1 negative. The foci of signet ring cells in the 2 primary cervical adenocarcinomas were diffusely CK7 and p16 positive and negative with CK20 and CDX2. Colorectal adenocarcinomas involving the cervix were typically diffusely positive with CK20, CEA, and CDX2; negative with CK7; and negative or focally positive with p16. Intestinal types of cervical AIS and adenocarcinoma exhibit a partial enteric immunophenotype, usually with diffuse expression of CDX2 and, in some cases, staining with CK20. They maintain their CK7 immunoreactivity and are usually p16 positive. Although there is immunophenotypic overlap, focal staining with CK20 together with diffuse CK7 and sometimes p16 positivity helps to distinguish intestinal types of cervical adenocarcinoma from involvement by a colorectal adenocarcinoma; CEA and CDX2 are of no value in this regard. CDX2 positivity in usual-type AIS adjacent to intestinal type and in occasional cases of pure usual-type AIS may be a reflection of early intestinal differentiation before this is morphologically apparent. Using a set of cases of AIS diagnosed in a single institution over a 7-year period (77 usual type; 13 intestinal type), intestinal type was more likely to be associated with early invasive adenocarcinoma than usual type (31% vs 17%), suggesting that intestinal differentiation may be a risk factor for invasion in premalignant cervical glandular lesions.     

Electron microscopical and immunohistochemical study of human endometrial carcinoma with special reference to localization of estrogen receptors and carcinoembryonic antigen

Human endometrium, endometrial hyperplasia and endometrial carcinoma were observed by light microscope. Endometrial carcinoma was histologically divided into Grade I (53 cases), Grade II (10 cases), and Grade III (7 cases). According to the results of electron microscopical analysis, cancer cells in GIII were smaller and showed a higher N/C rate and less mitochondria in the cytoplasma than those of GI and GII. Rough endoplasmic reticula were well developed in GI and GII compared with GIII. Immunohistochemically, ER localized in 54% cases of endometrial carcinoma, and decreased in positive rates of undifferentiated carcinoma. The metaplastic area in carcinoma showed the localization of ER and CEA. A close correlation between ER and CEA was demonstrated in endometrial carcinoma. Ultrastructurally, rough endoplasmic reticula were well developed in the cytoplasma of cancer cells in the strong positive cases of ER and CEA. It has been proved that histological detection of ER and CEA in endometrial carcinoma is very important in deciding the diagnosis, prognosis and therapy.     

Expression of RCAS1 in female genital organs.

Receptor-binding antigen expressed on a human uterine adenocarcinoma cell line, SiSo (RCAS1), has been reported to be a prognostic factor of various malignant tumors, and it has also been proven to induce apoptosis of lymphoid cells. However, its normal distribution and function have not yet been elucidated. The purpose of this study was to disclose the distribution of RCAS1 expression in normal female genital organs. Immunohistochemical staining using anti-RCAS1 and anti-MIB-1 antibodies was performed on 123 surgical specimens of a histologically normal uterus, ovary, or fallopian tube from 66 patients, and the apoptotic index was determined. In uterine cervical glands, the expression of RCAS1 was seen in 93% of the cases, and it was mainly localized in the superficial cervical glands. Near the areas of squamous metaplasia, RCAS1 was strongly expressed in all samples. In the uterine cervical squamous epithelium, RCAS1 was seen in 84% of cases. In the uterine corpus, RCAS1 was seen in 87% of all cases, and it was mainly expressed in the endometrial glands of basalis layer. There was significant positive correlation between age and RCAS1 expression, but no significant difference was found regarding the endometrial status and RCAS1 expression in endometrium. No significant correlation was found between RCAS1 expression and MIB-1 index/apoptotic index. RCAS1 may affect these metaplastic processes and tumor progression.     

The Reliability of a Cytological Prediction of Cervical Adenocarcinoma In Situ

A spectrum of changes precedes clinical invasive adenocarcinoma of the cervix. Cytological and histological criteria for the diagnosis of adenocarcinoma in situ (ACIS) are becoming more clearly defined. A 5-year prospective study was undertaken to test the accuracy of a cytological prediction of ACIS. From a total of 290,000 cervical smears 54 predictions of ACIS were made: 33 (61%) alone and 21 (39%) with associated squamous carcinoma in situ (SCIS). The rate of reporting ACIS was compared to the rates for intraepithelial and invasive squamous lesions and for frank invasive adenocarcinoma. The findings suggest that ACIS is being underdiagnosed. Forty-seven patients were adequately investigated; 46 had intraepithelial or invasive malignancy. There were 10 cases of ACIS, 10 ACIS with SCIS, 9 microinvasive adenocarcinoma, 5 invasive adenocarcinoma, 2 microinvasive adenosquamous carcinomas, 1 invasive adenosquamous carcinoma, 8 SCIS and 1 endometrial carcinoma. There was one true false positive report. Thus cervical glandular neoplasia was confirmed in 37 patients (79%), 13 of these having adenosquamous tumours. Because 98% of patients had in situ or invasive malignancy and because 36% of cases were invasive (though mostly microinvasive) prompt investigation, by cone biopsy, must follow a cytological report of ACIS.     

The distribution of mucins, carcinoembryonic antigen, and mucus-associated antigens in endocervical and endometrial adenocarcinomas

The presence and distribution of mucins, carcinoembryonic antigen (CEA), and mucus-associated antigens M1, M2, and M3 were investigated in 22 normal endocervices, 25 normal endometria, 25 endocervical adenocarcinomas, and 32 endometrial adenocarcinomas to determine their contribution in the differential diagnosis of endocervical and endometrial adenocarcinoma. Sections of formalin-fixed paraffin-embedded tissues were stained with conventional histochemical stains such as d-PAS and Alcian blue to investigate the distribution of mucins. For the demonstration of CEA and the mucus-associated antigens an indirect immunoperoxidase technique was used. In the present study d-PAS and Alcian blue stains, as well as immunohistochemistry of CEA, did not contribute to the discrimination between adenocarcinomas of the endocervix and endometrium. Immunohistochemistry of mucus-associated antigens showed a positive reaction of M3 in the majority (68%) of the endocervical carcinomas. In contrast, if foci of endocervical-type metaplasia were excluded, M3 was absent in tumor cell cytoplasm of endometrial adenocarcinomas. Furthermore, the expression of M2 without the presence of the other mucus antigens in tumor cell cytoplasm, as seen in 24% of the endometrial adenocarcinomas, was never found in endocervical adenocarcinomas.     

Increased incidence of adenocarcinoma of uterine cervix.

A greater than expected incidence of adenocaricinoma of the uterine cervix is reported. Among 41 cases of cervical carcinoma, 14 (34%) were adenocarcinoma. Clinicopathologic data for these cases are summarized. Eleven of the 14 cases were pure adenocarcinomas; 3 were mixed adenosquamous carcinoma. The value of cytopathology is demonstrated in the 7 of 9 pretreatment cervical cytologies whereby adenocarcinoma was indicated (an accuracy rate of 78%). The other 2 revealed abnormal cells in which malignancy was a possibility. Three cases clinically were initially considered endometrial adenocarcinoma, but by our classification criteria, including Alcian blue staining for cervical mucin content of acid mucopolysaccharide, they were more specifically identified as primary endocervical in origin.     

Detection of human papillomavirus DNA in malignant lesions from Chinese women with carcinomas of the upper genital tract

OBJECTIVE: The aim of this study was to determine the prevalence of high-risk oncogenic human papillomaviruses (HPVs) in malignant lesions from Hong Kong Chinese women with carcinomas of the upper genital tract. METHODS: The presence of high-risk HPVs in 55 cases of endometrial adenocarcinomas and 60 cases of primary epithelial ovarian cancers was detected by polymerase chain reaction (PCR) using consensus primers complementary to late 1 (L1) gene of the genital HPVs. Amplified PCR products were verified and typed by Southern blot analysis using (32)P-labeled DNA probes prepared from cloned HPV-16 and -18 plasmids. To confirm the presence of high-risk HPV types in the tumor tissues, PCR amplification using HPV type 16- and 18-specific primers for part of the E6 gene were also carried out. RESULTS: While HPV-18 was not detected, HPV-16 DNA sequences were identified in 5 (9.1%) of the 55 studied endometrial carcinoma samples. Of the 5 HPV-16-positive cases, there were 4 stage I, and 1 stage II endometrial cancer. In addition, 6 (10%) of the 60 epithelial ovarian carcinomas were positive for high-risk HPVs, which included 5 cases with HPV-16 and 1 case with HPV-18. Clinical staging revealed that 5 of the 6 HPV-positive cases were stage I and the remaining case was stage III ovarian cancer. Histology of the 6 HPV-positive cases showed that there were 1 case of clear-cell adenocarcinoma, 1 case of mucinous cystadenocarcinoma, and 4 cases of mucinous tumor of borderline malignancy. No other HPV types were detected. CONCLUSION: High-risk HPV was detected in approximately 10% of the tumor samples from women with upper genital tract carcinomas. As compared to the high positive rate of HPV infections in cervical cancer, it appears that HPV infection plays a relatively minor role in the pathogenesis of endometrial and ovarian carcinomas.     

Immunohistochemical demonstration of amylase in endometrial carcinomas

Cellular localization of amylase in 100 endometrial carcinomas was studied by the immunoperoxidase method using an antibody to human pancreatic amylase. Amylase activity was observed in 12 tumors, localizing in the cytoplasm of tumor cells. They were seven well-differentiated adenocarcinomas, one poorly differentiated adenocarcinoma, one papillary serous carcinoma, two mucinous carcinomas, and one adenocarcinoma with squamous differentiation. Of these, many amylase reactive cells were found in one well-differentiated adenocarcinoma, one papillary serous carcinoma, and one mucinous carcinoma. The remaining nine tumors contained a few to a moderate number of amylase reactive cells. Although serum levels of amylase were not examined in the present study, the results suggest that amylase may be a potential tumor marker for some endometrial carcinomas.     

子宫内膜癌手术前分段诊断性刮宫

目的 评价分段诊断性刮宫（分段诊刮）对判断子宫内膜癌的组织类型以及判断宫颈是否受累的价值。方法 对６９１例子宫内膜癌术前均行分段诊刮,并对分段诊刮和手术切徐标本的病理诊断结果进行比较分析。根据肿瘤与颈管的组织学关系不同,将颈管刮出物分为４型：Ⅰ型即肿瘤组织完全与颈管组织分离;Ⅱ型即肿瘤与颈管上皮相连;Ⅲ型即肿瘤润宫颈间质;Ⅳ型即标本中仅见肿瘤组织。结果 ⑴分段诊刮与手术切除标本病理诊断为子宫内膜癌     

Endometrial mucinous microglandular adenocarcinoma: morphologic, immunohistochemical features, and emphasis in the human papillomavirus status.

We report two cases of endometrial microglandular adenocarcinoma, a rare neoplasm, which, in its morphologic features, mimics cervical microglandular hyperplasia and mucinous proliferations of endometrium. The criteria for a correct pathological diagnosis, such as clinical, morphologic, and immunohistochemical data, are emphasized. For the first time, we probed to establish whether endometrial mucinous microglandular adenocarcinoma could be correlated to human papilloma virus (HPV) infection by using polymerase chain reaction amplification (PCR) of tumoral DNA. Similar to previous studies reported in the literature, the present lesions, occurring in postmenopausal women, immunohistochemically showed positivity for B72.3, Ca 125, CEA, Vimentin, estrogen and progesterone receptors, and negativity for p53. Molecular study by PCR amplification of tumor DNA showed no signal for HPV DNA in any of these cases; thus, this variant of endometrial carcinoma is not caused by the HPV infection, but probably by other pathogenetic mechanisms, such as an accumulation of the mutations, which arrive in old age or as the consequence of a peculiar hormonal situation.     

Secretory adenocarcinoma of the endometrium

Secretory adenocarcinomas of the endometrium are uncommon tumors distinct from clear cell carcinomas. We reviewed nine cases that included the original endometrial curettings and the specimens of uteri with both adnexa [total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO)]. The patients' ages ranged from 36 to 79 years (with an average of 55 years). Six women were postmenopausal, and most complained of vaginal bleeding. Two patients were nulliparous and the others had one to four children. Four patients were obese, of whom one was diabetic and hypertensive. Eight tumors were of grade I and one was grade II. The histologic pattern was comparable to that of secretory endometrium, days 17 to 22, and the glands were positive with periodic acid-Schiff (whether predigested or not); they were partly positive with alcian blue and negative with Best Carmine. The carcinoma in one case was positive for carcinoembryonic antigen; all cases were negative with alpha-fetoprotein. Six patients were staged as IA and three as IB. One 47-year-old patient had a concurrent endometrioid adenocarcinoma (grade II) of the right ovary with squamous, clear cell, and mucinous components. Three cases had no tumour penetration of the myometrium while in the others penetration varied from 5 to 70%. One patient received intracavitary radium prior to TAH-BSO and two had postoperative radiation. All patients are alive 11 to 113 months following surgery. Secretory adenocarcinoma of the endometrium should be separated from clear cell carcinoma, as it has the pattern of secretory endometrium day 17 to 22, is very well differentiated, and has a relatively good prognosis.