Mixed papillary adenocarcinoma and transitional cell carcinoma of the uterine cervix

A mixed papillary adenocarcinoma and transitional cell carcinoma (MAcTcc) was discovered in the uterine cervix of a 38-year-old woman. A condylomatous papillary lesion was found in the uterine cervix during a colposcopic study and histopathological examination showed that the tumor was composed of two different neoplastic subtypes. One was an adenocarcinoma (AC) component showing papillary and tubular structure with endocervical and intestinal differentiation; the other was a transitional cell carcinoma (TCC) component showing papillary excrescence mimicking papillary TCC of urothelial origin. To characterize the tumor, an immunohistochemical study of cytokeratins (CK) was performed. The AC component showed immunoreactivities similar to conventional adenocarcinomas: positive immunoreactivity of low-molecular-weight cytokeratins 7, 8 and 19, and negative immunoreactivity of CK20 and high-molecular-weight cytokeratin (34βE12). The lower epithelial layer of the TCC component showed different immunoreactivity, but the superficial epithelial layer had similar immunohistochemical findings to the AC component. These findings indicate that the TCC component had the cellular character of AC rather than that of TCC or squamous cell carcinomas. This is thought to be the first report of a MAcTcc of the uterine cervix.     

Dermal adnexal differentiation in a squamous cell carcinoma of the uterine cervix

The first case of a keratinizing squamous cell carcinoma of the uterine cervix with differentiation toward dermal adnexal structures is reported. A review of skin-associated structures in the non-neoplastic uterine cervix is given and the histogenesis discussed. Recent literature dealing with extracutaneous neoplasms with sebaceous differentiation is cited.     

Adenoid squamous cell carcinoma of the larynx: an uncommon histological variant of squamous cell carcinoma

Adenoid squamous cell carcinoma (ASCC) or acantholytic squamous cell carcinoma is a well-recognized variant of squamous cell carcinoma. ASCC commonly occurs in the sun-exposed areas of the skin and has only rarely been observed in mucosal sites. We report a case of ASCC in the larynx of a 75-year-old man with a history of odynophagia and dysphonia of 3 months' duration that presented as an exophytic lesion on the right vocal cord. Biopsy was performed and the histological diagnosis was squamous cell carcinoma. Treatment consisted of total laryngectomy and radical neck dissection. Microscopically, the tumor showed a prominent alveolar pattern with cystic degeneration of the neoplastic epithelium and formation of pseudoglandular structures. In the lumina there were acantholytic cells. Transition areas from conventional squamous cell carcinoma to adenoid pattern were found. To the best of our knowledge this is only the third case of ASCC reported in the larynx. We reviewed the nine mucosal ASCCs of the upper aerodigestive tract reported. The assertion that these tumors are associated with an aggressive behavior and poor prognosis cannot be estimated in this review as the number of cases is small and the tumors are located in different places.     

A study of the value and prognostic significance of mucin staining in squamous cell carcinoma of the uterine cervix

One hundred and eighty-one cases of squamous carcinoma of the uterine cervix, which had been retrieved from the archives of Aberdeen Royal Hospital, from 1974 to 1988, were stained with periodic acid-Schiff following diastase and alcian blue to ascertain the value and prognostic significance of demonstrating the presence of mucin. Each case was typed and graded on a representative haematoxylin and eosin section, while the age at diagnosis, stage and survival (within a minimum five year follow-up) was obtained from examination of hospital case notes and death certificates. The data was analysed by Cox regression which revealed that the demonstration of mucin, either by both stains or only one method, had no bearing on prognosis. On this basis, it is concluded that routine mucin staining of squamous carcinomas of the uterine cervix is not justified.     

Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: An autopsy case and literature review

An autopsy case of squamous cell carcinoma of the uterine cervix, which developed cardiac intracavitary metastasis in a 28-year-old Filipina, is reported. At autopsy, the right ventricle contained a soft, red-purple, cauliflower-like mass. Histologically, this mass was made up of sheets of malignant squamous cells similar to the primary uterine foci. The metastases were extensive and associated with multiple organ involvement. Although this case was stage Ib at operation, vascular invasion at the primary site was characteristic, and the intracavitary tumor of the right ventricle developed without myocardial involvement. The carcinoma of the primary site extended along the inferior vena cava and settled as an intracardiac obstructive mass. A literature review (including the present case) disclosed only 14 uterine cervical carcinomas with right intracavitary metastasis. The mean age of these patients was 46 years of age (range, 28-77 years). The clinical stage was Ib in two cases, IIa in one case, IIb in six cases, and IIIb in two cases. The prognosis of these cases was poor; 13 of the patients died at an average of 19.1 months after diagnosis.     

Glassy cell carcinoma of the uterine cervix

Two cases of glassy cell carcinoma which is considered to be a poorly differentiated mixed adenosquamous cell carcinoma in the uterine cervix are described. Its cytologic and histologic findings are distinctive. The tumor cells had moderately amount and ground-glass cytoplasms, and had large nuclei containing a prominent nucleoli.     

Small-cell neuroendocrine carcinoma of the uterine cervix associated with micro-invasive squamous cell carcinoma and adenocarcinoma in situ

A case of small-cell neuroendocrine carcinoma of the uterine cervix associated with squamous cell carcinoma and adenocarcinoma In situ is reported. The tumor consisted mainly of uniform small cells with a population of intermediate cells that resembled carclnold tumor cells. Foci of micro-invasive squamous cell carcinoma and adenocarcinoma In situ were recognized separately, adjacent to the main tumor. Both Gri-mellus stain and Immunostalning of serotonin were positive for small-cell and Intermediate-cell carcinoma. Neurosecre-tory granules were demonstrated by electron microscopy. Mlcroaclnl with positive mucln staining and microvilli-like structures suggested glandular or exocrine differentiation of trie tumor. Three distinctive types of differentiation, neuroendocrine, exocrine and squamous characteristics, were expressed In the tumor.     

Leptomeningeal metastasis in a patient with squamous cell carcinoma of the uterine cervix: Report of a case and review of the literature

Leptomeningeal spread of advanced squamous cell carcinoma (SCC) of the uterine cervix is unusual. To our knowledge, very few cases were reported in the English literature. We report a case of a 39-yr-old woman who presented with leptomeningeal metastasis from a stage IIb SCC of uterine cervix. The diagnosis was made by cytomorphological examination of smears obtained from cerebrospinal fluid. The cytomorphological features are demonstrated.     

Smear cytology findings of large cell neuroendocrine carcinoma of the uterine cervix

Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare tumor. Moreover, there are only three reports to date that have focused on the cytologic findings of cervical LCNEC. We report the case of a 59‐year‐old Japanese woman with cervical LCNEC combined with small cell carcinoma (SmCC). Cytologic specimens from the uterine cervix demonstrated large cells with coarse chromatin and prominent nucleoli. Frequent mitotic figures were also observed. Curettage of the uterine endometrium revealed an endometrioid adenocarcinoma with squamous differentiation; i.e., an adenoacanthoma. Histologic examination of surgically resected uterine cervical tissue revealed LCNEC with minor foci of SmCC. Neuroendocrine differentiation in LCNEC was confirmed by immunohistochemistry for synaptophysin and CD56. Cytotechnologists or pathologists need to consider a differential diagnosis of LCNEC while examining cervical cytologic specimens; therefore, it is important to correctly identify the cytologic characteristics of this tumor. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Adenoid basal carcinoma combined with invasive squamous cell carcinoma of uterine cervix: A case report of a 37‐year‐old woman and literature review

Adenoid basal carcinoma (ABC) is uncommon malignancy of the uterine cervix and it can be pure or combined with cervical intraepithelial lesions. There were less than 20 cases of ABC combined with invasive squamous carcinoma (mixed type) in English literature. These cases had similar properties as seen at postmenopausal women and diagnosed with abnormal cervical smear findings. Here we present a case of 37‐year‐old woman who suffered from spotting and received endocervical curettage. The pathological report revealed squamous cell carcinoma (SCC) of the cervix. The patient underwent type 3 radical hysterectomy and bilateral pelvic and para‐aortic lymph node dissection. The final pathological report revealed SCC coexisting with ABC. Human papillomavirus (HPV) 16,18 and others (11 types) were negative in both components of the mixed tumor by in situ hybridization detection. Our case was cytokeratin 7 negative, cytokeratin 8 positive and p63 positive which supports the hypothesis that mixed type cervical carcinoma originates from endocervical reserve cells.     

Grading system of lymphatic invasion according to D2-40 immunostaining is useful for the prediction of nodal metastasis in squamous cell carcinoma of the uterine cervix

AIMS: To determine the relationship between lymphatic invasion detected by D2-40 immunostaining and nodal metastasis in squamous cell carcinoma (SCC) of the cervix. METHODS AND RESULTS: Seventy-five cases of FIGO stage IB to IIB SCC of the cervix, treated by radical hysterectomy and lymph node dissection, were examined. Immunohistochemistry for D2-40 was performed. Overestimation of lymphatic invasion on conventional histological examination was demonstrated by assessment of D2-40 immunoreactivity in 22 cases. A significant difference in lymphatic invasion detected by D2-40 immunostaining was found between the metastatic group (30 cases) and the non-metastatic group (45 cases) (P < 0.001). A grading system (grade 0-2) of lymphatic invasion according to D2-40 immunostaining was devised. Subsequently, the frequency of nodal metastasis significantly increased in accordance with the grade of lymphatic invasion (P < 0.001) and in eight cases with grade 2, seven cases (87.5%) had nodal metastasis. CONCLUSIONS: In cervical SCC, a grading system for lymphatic invasion according to D2-40 immunostaining is useful for the prediction of nodal metastasis and grade 2 lymphatic invasion is a strong predictor of nodal metastasis.     

Notch信号通路与Slug在调控宫颈鳞状细胞癌上皮-间充质转变中的意义

目的探讨Notch信号通路与Slug在宫颈鳞状细胞癌上皮-间充质转变(EMT)中的作用机制。方法收集临床慢性宫颈炎及宫颈鳞状细胞癌标本,分别用免疫组化及Western blot检测Notch1、NICD1、Slug、E-cadherin、α-SMA蛋白表达情况,Real-Time PCR检测Notch1、SlugmRNA表达情况。结果与慢性宫颈炎比较,Notch1、NICD1、Slug和α-SMA在宫颈鳞状细胞癌中表达增加(P<0.01),E-cadherin蛋白在癌组织中的表达降(P<0.01)。结论 Notch信号通路和Slug可能通过调控EMT在宫颈鳞状细胞癌的侵袭转移过程中发挥作用     

Smear cytological features of large cell neuroendocrine carcinoma of the uterine cervix in pregnancy: A case report and review of the literature

Large‐cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare aggressive tumor. The examination of a cervicovaginal smear from a 31‐year‐old patient diagnosed with LCNEC after a cervical polypectomy during the 32nd week of pregnancy was carried out. The observed atypical cells had large cytoplasm, increased nucleus: cytoplasm ratio with the nucleus containing coarse, dispersed chromatin, and were arranged in a pseudorosette formation, which all confirmed the diagnosis. In addition, adenocarcinoma in situ (AIS) was determined in the histopathological examination of the subsequent hysterectomy material. Given the rarity of this condition, we present and discuss the case herein.     

Combined signet ring cell and glassy cell carcinoma of the uterine cervix arising in a young Japanese woman: a case report with immunohistochemical and histochemical analyses

Signet ring cell carcinoma and glassy cell carcinoma are both rare histological subtypes of uterine cervical cancer. This report is of a case of uterine cervical carcinoma arising in a 29-year-old woman who had major components of signet ring cell carcinoma and glassy cell carcinoma within the same tumor. Histochemical and immunohistochemical analyses, including high and low molecular weight cytokeratins, p63 and MUC5AC, additionally demonstrated the squamous and adenocarcinomatous differentiation in the neoplastic cells, which showed otherwise unclassifiable morphology on the haematoxylin-eosin sections. A wide range of differentiation described above supports the speculation that glassy cell carcinoma may arise from the multipotential immature cells that can differentiate into both squamous and glandular cells. It would be precise to classify this tumor as adenosquamous carcinoma. Although adenosquamous carcinoma is not a rare histological subtype in the uterine cervix, it should be necessary to report the presence of glassy cells and signet ring cells when present because the presence of both components is associated with an unfavorable clinical behavior.     

Adenoid basal carcinoma of the cervix uteri: A case report

We report a rare case of adenoid basal carcinoma of the uterine cervix, unexpectedly found in a uterus resected for the treatment of cervical Intraepithelial neoplasia (CIN) 3. The patient was a 47-year-old Japanese female. She received a total abdominal hysterectomy under a diagnosis of CIN 3 of the cervix. Grossly, there were no significant findings in the surgical specimens. Microscopically, in seven of the 12 blocks of the cervix examined, scattered small nests of uniform small cells, which extended 4 mm below the epithelial surface, with dark nuclei and scant cytoplasm were observed. Peripheral palisading as well as the formation of gland-like or acinar structures were noted. The latter were positive for mucicarmine. Stromal reaction was not obvious. There were also foci of squamous differentiation in some portions of the small nests. Occasional mitoses as well as large atypical cells were also seen in this area. Immunohistochemically, the foci of squamous differentiation were positive for carcinoembryonic antigen. The epithelial surface In other portions showed CIN 3 with crypt extension. Distinction between adenoid basal carcinoma of the cervix and other diseases, such as adenoid cystic carcinoma and squamous cell carcinoma with basaloid features, is Important for clinical management because the clinical behavior of adenoid basal Carcinoma is less malignant.     

Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles

AIMS: Primary squamous cell carcinoma of the thyroid gland is uncommon. This study aims to identify the clinicopathological features and the pattern of expression of cytokeratins and oncoproteins in this tumour. METHODS AND RESULTS: Histological slides from Chinese patients with thyroid cancer treated in our institution from 1980 to 1999 were reviewed. Patients with primary squamous cell carcinoma of the thyroid were identified and their clinical records were analysed. The expression of cytokeratins (CKs), p53 and p21 in these cases were also studied by an immunohistochemical method. Four women (mean age 71 years) with squamous cell carcinoma of thyroid were found. The main presenting features were signs and symptoms of airway obstruction in three patients and neck swelling in one. The tumours were located at the right lobe (n=2), left lobe (n=1) or in both lobes of the thyroid (n=1). One patient died shortly after admission and the other three died within 4 months after thyroidectomy. The p53 protein was positive in 50% (2/4) of the tumours and p53+ tumours were poorly differentiated. The tumours were negative for p21. CK19 was expressed in all the tumours while CK7 expression was noted in 3/4 of the tumours. One carcinoma showed focal positivity to CK18. The tumours were negative for CKs 1, 4, 6, 10/13 and 20. The pattern of cytokeratin expression in squamous cell carcinoma of the thyroid gland was different from carcinoma showing thymus-like differentiation (CASTLE) of the thyroid gland and oesophageal squamous cell carcinoma. CONCLUSIONS: Squamous cell carcinoma of the thyroid has aggressive clinical behaviour and characteristic CK expression pattern. p53 over-expression in these tumours was associated with tumour differentiation.     

宫颈正常细胞和宫颈鳞状细胞癌、腺癌组织中HPV感染基因型的分布

目的 观察宫颈正常细胞、宫颈鳞状细胞癌和腺癌组织标本中人乳头瘤病毒(human papillomavirus,HPV)感染的基因型分布情况及临床意义.方法 采用PCR和基因芯片检测技术对1 047例宫颈正常细胞、161例宫颈鳞状细胞癌和82例宫颈腺癌组织标本进行23种HPV基因分型检测,并对受检者进行相关资料分析.结果 1 047例宫颈细胞正常者检出HPV感染为109例,HPV感染率为10.41％(109/1 047);161例宫颈鳞状细胞癌检出HPV感染者146例,HPV感染率为90.68％(146/161);82例宫颈腺癌检出HPV感染者59例,HPV感染率为71.95％(59/82).结论 PCR与基因芯片检测技术可用于宫颈细胞和组织标本检测,一次可检测23种HPV基因型,对我国女性宫颈HPV感染的分子流行病学调查、宫颈鳞状细胞癌及腺癌的防治及其疫苗的研究具有十分重要的意义.     

Adenoid basal carcinoma of the uterine cervix: report of two cases with reference to adenosquamous carcinoma

Adenoid basal carcinoma (ABC) of the uterine cervix is a rare neoplasm with excellent prognosis. Differential diagnosis between ABC and an ABC-like lesion of adenosquamous cell carcinoma (ASC) of the cervix is important due to their contrasting prognosis. Reported herein are two cases of ABC that have been compared with seven ASC exhibiting ABC-like lesions from approximately 2600 resected uterine cervical malignancies diagnosed at Shikoku Cancer Center. The two ABC were incidentally found in the uterine cervix of 69-year-old and 59-year-old Japanese women due to cervical intraepithelial neoplasia grade 3 and to squamous cell carcinoma, respectively. The ABC consisted of infiltrating nests of basaloid cells with low nuclear atypia. The patients remained alive without recurrence for 9 years and 18 months, respectively. An ABC-like lesion was defined as basaloid cell nests simulating ABC, but with some features indicating malignant potential. However, the differential diagnosis was sometimes difficult because two of seven ABC-like lesions were originally diagnosed as ABC. Immunohistochemically, cytokeratin 7 was negative for the basaloid cells of two ABC, but positive for six of six ABC-like lesions of ASC, while cytokeratin 8 was positive for both ABC and ASC. This cytokeratin pattern might provide a good tool for distinguishing between ABC and an ABC-like lesion of ASC when the histological findings are equivocal.