Mesonephric adenocarcinoma of the uterine cervix: a case report with immunohistochemical and ultrastructural studies

A very rare case of mesonephric adenocarcinoma with lobular mesonephric hyperplasia in the uterine cervix of a 46-year-old female is presented. The lesion was a 4cm, exophytic, almost circumferential, whitish yellow, friable mass in the uterine cervix. Microscopically, the tumor was composed predominantly of atypical round to polygonal cells arranged in a ductal, tubular, or papillary pattern. The tumor involved the entire cervix with varying depths of penetration. Lobular mesonephric hyperplasia was also observed in the lateral cervical wall and adjacent to the tumor. Immunohistochemically, the tumor was positive for CAM5.2, CK7, epithelial membrane antigen, calretinin, and chromogranin A, and was negative for vimentin, carcinoembryonic antigen, estrogen and progesterone receptors, and CD10. An ultrastructural analysis showed telolysomes, which were characteristic features of mesonephric epithelium. The patient was alive without disease at 4 months after surgery.     

Localized amyloidosis of the uterine cervix

Summary Localized amyloidosis of the uterine cervix was found in a 56-year-old woman. The firm enlarged cervix showed massive tumorous amyloid deposition. In the amyloid deposits there were foci of ossification and calcification. An infiltrate of multinucleated giant cells, histiocytes, lymphocytes, and plasma cells was seen adjacent to the amyloid deposits. Immunohistochemically, the amyloid reacted with antisera against A-lambda, amyloid protein of immunoglobulin lambda light chain origin. This indicated that the amyloid protein was of immunoglobulin origin in this rare case of localized amyloidosis of the uterine cervix.     

Comparative cytologic findings of in situ and invasive adenocarcinoma of the uterine cervix

The cytologic findings in 13 cases of cervical adenocarcinoma in situ (mean age 33.9 yr) were compared with those in 9 cases of cervical invasive adenocarcinoma (mean age 45.7 yr). All diagnoses were confirmed by biopsy. the major differences found were that a necrotic background (66% invasive vs. 0% in situ) and macronucleoli (77% invasive vs. 0% in situ) were more common in invasive cases, whereas associated squamous-cell dysplasia (69% in situ vs. 0% invasive) was more common in in situ cases. Other differences included syncytial tissue fragments with irregular cell borders, frequent cell drop-off, and markedly atypical single columnar cells (or markedly atypical naked nuclei) seen more commonly in invasive cases, whereas monolayer sheets and/or syncytial tissue fragments with smooth borders and rare cell drop-off were more common in in situ cases. Although none of these features is diagnostic individually, in combination they are helpful in distinguishing between in situ and invasive adenocarcinoma. Nine of 13 of the in situ cases showed associated squamous-cell dysplasia. in all nine of these cases, the glandular dysplasia was overlooked or underestimated in severity on original cytologic diagnosis. This suggests that the presence of a squamous lesion may lead to decreased detection of glandular lesions, perhaps because the features of squamous lesions are more well known; thus they are more easily recognized, at the expense of glandular lesions. All invasive adenocarcinomas were identified as carcinoma in the original diagnosis with seven specified as invasive adenocarcinomas. © 1995 Wiley- Liss, Inc.     

Squamous cell characteristics in small cell carcinoma of the uterine cervix: histological, immunohistochemical, and ultrastructural study in xenografted small cell carcinoma

Small cell carcinoma of the uterine cervix is a rare type of gynecological tumor that frequently expresses neuroendocrine differentiation. Its histological origin is unclear. We examined the histopathological characteristics of small cell cervical carcinoma in a patient with elevated serum adrenocorticotropin hormone. We then studied the morphological alteration in xenotransplanted tumors (passages 1–9) using immunohistochemistry and electron microscopy. The primary cervical tumor was characterized by a sheetlike arrangement of uniform small cells with hyperchromatic nuclei and a high nucleocytoplasmic ratio. A ribbon-like or trabecular pattern was also observed in a small area of the tumor. Neuron-specific enolase, chromogranin A, and S-100 were positive for the tumor cells, but cytokeratin was negative. Dense-core granules were detected by electron microscopy. In the xenografted tumor, a serial change from squamous cells to round-to-oval cells was observed. Cytokeratin was immunohistochemically stained in the squamous tumor cells but not in the other tumor cells. In contrast, chromogranin A was stained in some of the round-to-oval cells. Basal lamina underlaid the squamous tumor cells, and desmosome-like junctions were apparent. The cytoplasm was filled with well-differentiated organelles including electron-dense tonofilaments. Elliptical tumor cells resembled the primary carcinoma ultrastructurally. These findings suggest that small cell cervical carcinoma with neuroendocrine properties shares the characteristics of squamous cell carcinoma.This study was presented at the 24th Annual Meeting of the Clinical Electron Microscopy Society of Japan, Okayama, September 17, 1992.     

Carcinoid tumour of the uterine corpus

Summary A carcinoid tumour occurred in the uterine fundus causing an enlargement (12–14 weeks size). The patient did not have the carcinoid syndrome, despite elevated urinary 5-hydroxyindole acetic acid levels. The tumour had a typical organoid pattern with argentaffin-positive cells. Whilst a metastasis from an occult primary lesion cannot be entirely excluded, it is felt that this is a primary tumour most likely arising from resident endocrine cells in the endometrium.     

Human papillomavirus genomes in squamous cell carcinomas of the uterine cervix

The association between invasive cervical carcinoma and human papillomavirus (HPV) has now been established beyond doubt, but this is not necessarily a direct-and-effect association. To assess the causality of HPV, we analyzed HPV genomes in squamous cell carcinomas (SCCs) [corrected] of the uterine cervix by both blot hybridization and PCR. Genital HPV sequences were found in 231 (79%) of 294 SCCs by blot hybridization with more than five copies of entire HPV genomes identified in some cases including HPV 16 (92 cases), HPV 58 (32 cases), and HPV 52 (24 cases). By PCR-direct sequence analysis in 250 of 294 SCCs, genital HPV sequences were found in 240 samples (96%). The partial L1 sequences of HPV 16 were identified in 123 cases, and those of HPVs 18 and 31 were found in 24 and 20 cases, respectively. In addition, multiple HPV types were identified in 29 (12%) of 250 SCCs, and the HPV copy number, detected by PCR only, was less than 0.05. Marked discrepancies were therefore evident between the two analytical techniques. In this report, we discuss the causality of HPV for SCC with regard to the length of the viral genome, the amount of viral DNA, and multiple HPVs in single SCCs.     

Carcinoid tumor of the renal pelvis: Report of a case with positive urine cytology

A case of histologically and ultrastructurally confirmed carcinoid tumor of the renal pelvis is reported. the patient's urine sediment showed a few groups and sheets of polygonal malignant cells with scant cytoplasm and oval nuclei displaying chromatin clumping and micronucleoli. © 1995 Willey- Liss, Inc.     

Primary non-Hodgkin's lymphoma of the uterine cervix mimicking leiomyoma: case report and review of the literature

Primary malignant lymphoma occurring in the uterine cervix is a rare event. We report a case of primary non-Hodgkin's lymphoma of the uterine cervix mimicking leiomyoma. The immunophenotype of the tumor and the differential diagnostic approach to this uncommon malignancy also are presented.     

Postpartum microneuromas of the uterine cervix

The cervices of 300 hysterectomy specimens have been examined for the presence of abnormal nerves morphologically resembling traumatic neuromas. These were present in 165 uteri (55%) overall but in only two of the 48 nulliparous patients (4%), indicating a probable causation by parturition. The microneuromas could be graded. The larger, more complex lesions were associated with more extensive involvement of the cervix but not with increased parity.     

Nonneoplastic signet-ring cells in the gallbladder and uterine cervix. A potential source of overdiagnosis

We describe 3 cases of nonneoplastic signet-ring cell change in ulcerated mucosa, 2 of them in the gallbladder and 1 in an endocervical polyp. In the gallbladder cases, there were focal collections of signet-ring cells both on the mucosal surface and within the lumen of tubules, whereas in the endocervical polyp, the signet-ring cell aggregates were entirely confined to the mucosal surface. In all 3 cases, the signet-ring cells were positive for Mayer's mucicarmine and immunoreactive for keratin AE1/AE3. The lack of nuclear atypicality, the arrangement in superficial and intraluminal nests, and the admixture with histiocytes and other inflammatory cells are in keeping with the interpretation that the signet-ring cells are disrupted mucosal goblet cells exhibiting hyperplastic and degenerative changes. A review of the literature disclosed only other 2 previously reported cases of benign signet-ring cell changes in the gallbladder and none--to the best of our knowledge--in an endocervical polyp. Awareness of this phenomenon is of importance to avoid a potential overdiagnosis of signet-ring cell adenocarcinoma.     

Carcinoid tumour of the uterine cervix.

A carcinoid tumour of the cervix in a 64-year-old woman is described. It is the first time that this rare tumour has been associated with carcinoma-in-situ.     

A new view of the so-called adenoma malignum of the uterine cervix

 Adenoma malignum of the uterine cervix (mucinous type of minimal deviation adenocarcinoma, mucinous MDA), is a unique neoplasm that is difficult to diagnose owing to the deceptively benign appearance of the tumour cells. The present study was undertaken to explore the phenotypic expression of this tumour compared with those of non-neoplastic cervical tissues and of cervical carcinomas of various types. Ten cases of mucinous MDA, 50 cases with non-neoplastic cervical tissues, 13 of cervical adenocarcinoma including the mucinous (endocervical or intestinal type) and endometrioid types, and 2 of mucoepidermoid carcinoma were examined by various histochemical staining methods, including those for gastric mucins, pepsinogen, lysozyme, chromogranin A and carcinoembryonic antigen. The results revealed that mucinous MDA characteristically exhibited gastric phenotypes. The presence of gastric metaplasia was also demonstrated in 9 cases of mucinous MDA and in 5 of the other cases examined. The 7 endocervical-type adenocarcinomas also included 4 that expressed gastric phenotypes, and 2 of the 3 intestinal-type adenocarcinomas showed the same properties focally. These results indicate the presence of a group of lesions expressing gastric phenotypes in the uterine cervix and suggest a close relationship between these lesions. Cervical adenocarcinomas expressing gastric phenotypes are probably derived from MDA. Received: 16 June 1997 / Accepted: 16 December 1997     

Ceroid granuloma of the uterine cervix

An excision biopsy was taken from a 59-year-old woman with a small dark-brown lesion on the anterior lip of the cervix. The histology revealed an ulcerated surface epithelium with a band-like infiltrate of pigment containing macrophages in the subepithelial zone. Histochemical examination of the specimen revealed that the pigment was ceroid. This is, to the best of our knowledge, the first case report of ceroid granuloma of the uterine cervix.     

Foci of stromal melanocytes (so-called blue naevus) of the uterine cervix in Japanese women

Summary Foci of stromal melanocytes (FSM) of the uterine cervix have been known as extra-cutaneous blue naevus. However macroscopic and histological findings suggest that FSM of the cervix are analogous to dermal melanocytosis, rather than to cutaneous blue naevus and the lesions are more appropriately called stromal melanocytosis. FSM of the cervix have been considered rare, but our study showed that they are not uncommon in Japanese women occurring in 8.6% (42/ 486). The lesions were initially observed in the third decade of life and became most prevalent in the fifth decade (15/86 cases, 17.4%). In stroma of the cervix, stromal melanocytes (SM) were present where many peripheral nerve fibres were seen. SM of the cervix were positive for S-100 protein in immunohistochemical studies and were sometimes observed close to peripheral nerve fibres. Melanocytes were never observed in the ectocervical and endocervical epithelium, but only in the stroma of the cervix. We suggest that malignant melanoma of the uterine cervix may originate from SM.     

Ultrastructural features of adenoma malignum of the uterine cervix: demonstration of gastric phenotypes

Histochemical staining has shown that so-called adenoma malignum (the mucinous type of minimal deviation adenocarcinoma [mucinous MDA]) of the uterine cervix expresses gastric phenotypes. The present ultrastructural study was undertaken to explore the fine structure and phenotypic expression of this tumor, and to make comparisons with normal cervical glands and gastric pyloric mucosa. Post-embedding, double-immunogold staining for gastric gland mucous cell mucin (HIK1083-reactive mucin) and lysozyme revealed localization exclusively to the matrix and to the core of the mucin granules, respectively, both in mucinous MDA and gastric pyloric mucosa. Mucin granules of normal cervical gland cells lacked core structures and showed no immunoreactivity with HIK1083 or lysozyme. Thus, mucinous MDA was confirmed to be a tumor expressing gastric phenotypes ultrastructurally. Both markers should be useful for the identification of tumor cells.     

Promoter hypermethylation of CDH13, DAPK1 and TWIST1 genes in precancerous and cancerous lesions of the uterine cervix

Aberrant DNA methylation is an early event in carcinogenesis and could serve as an additional molecular marker for the early diagnosis. The study was performed to investigate the promoter methylation of DAPK1, CDH13, and TWIST1 genes in uterine cervix lesions in an effort to examine whether this epigenetic event is involved in the process of cervical carcinogenesis, and whether it might be used as a molecular marker of cervical lesions.We conducted a retrospective study of 60 uterine cervix specimens, including 8 normal tissue samples, 10 benign lesions, 28 precancerous lesions (CIN1-3), and 14 squamous cell carcinomas (SCC). DNA hypermethylation was investigated using methylation-specific PCR. Immunohistochemistry was used to find p16^INK4A overexpression.No hypermethylated promoters were detected in normal tissues and benign lesions. However, promoter hypermethylation of CDH13, TWIST1, and DAPK1 increased progressively from CIN1 to cancer, reaching values higher than 50% for cancer. DAPK1 and CDH13 displayed a significantly increased frequency of promoter methylation with progressively more severe cervical neoplasia (p < 0.05). A statistically significant association was observed between p16^INK4A expression and hypermethylation of DAPK1, TWIST1, and CDH13 (p < 0.0001).Hypermethylation of CDH13, DAPK1, and TWIST1 promoters is an early event in the initiation and progression of cervix neoplasia. CDH13, DAPK1, and TWIST1 genes are potential biomarkers of cervical cancer risk.