1 Diagnostic Pathology 2011 Vol: 6(1):51. DOI: 10.1186/1746-1596-6-51

Coexistence of early microinvasive endometrioid adenocarcinoma and CIN3 in the uterine cervix in a 32-year-old Japanese woman

Simultaneous occurrence of early microinvasive endometrioid adenocarcinoma (EMEA) and CIN 3 in the uterine cervix is very rare in Japan. A 32-year-old Japanese woman was pointed out to have atypical cells in the cervical cytology. Colposcopic examination revealed irregular lesions in the cervix, and a biopsy showed simultaneous EMEA and CIN3. The EMEA was grade I and CIN3 corresponded to severe dysplasia/carcinoma in situ. Hysterectomy and lymph nodes dissection were performed. Grossly, mucosal irregularity and erosion were seen in the cervix. No tumor formation was recognized. The cervix was examined by serial sections. Microscopically, there were a tiny adenocarcinoma (0.5 cm in diameter and 0.3 cm in depth) and broad areas of CIN3. The adenocarcinoma was EMEA without mucins. The EMEA was FIGO stage 1A1. Immunohistochemically, the EMEA was positive for pancytokeratins (AE1/2 +++, CAM5.2 ++), cytokeratin (CK) 34βE12 +, CK5/6 +, CK7 +, CK18 +++, CK19 ++, CA19-9 +, CA125 +++, p53 +, ER +++, PgR +++, while it was negative for CK8, CK14, CK20, EMA, vimentin, CEA, desmin, smooth muscle actin, p63, chromogranin, synaptophysin, CD56, CD68, HER2/neu, MUC1, MUC2, MUC5AC, and MUC6. The CIN 3 was positive for pancytokeratins (AE1/2 +++, CAM5.2 +), cytokeratin (CK) 34βE12 +++, CK5/6 +++, CK7 +, EMA, CA19-9 +, CA125 +, p53 +, p63 +++, ER +++, and MUC1 +, while it was negative for CK8, CK14, CK18, CK19, CK20, vimentin, CEA, desmin, smooth muscle actin, chromogranin, synaptophysin, CD56, CD68, PgR, HER2/neu, MUC2, MUC5AC and MUC6. The lymph nodes showed no metastatic lesions (0/34). In conclusion, the author reported a rare case of simultaneous EMEA and CIN 3 with extensive immunohistochemical findings. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2229343835388013.

Mentions
Figures
Figure 1: Biopsy of uterine cervix. The biopsy shows atypical glands with hyperchromatic nuclei and with structural atypia. This lesion is regarded as adenocarcinoma. HE, ×100. Figure 2: Biopsy of uterine cervix. The biopsy shows atypical squamous lesion. The atypical cells showed hyperchromatic nuclei and occupy all layers. The polarity and stratification are lost. The lesion was regarded as CIN3. HE, ×100. Figure 3: Gross features of resected uterus. The cervix shows irregularity and erosions. No apparent tumor is seen. Figure 4: Microscopic features of the resected uterus. The adenocarcinoma component The adenocarcinoma is endometrioid adenocarcinoma. The carcinoma is small with mild invasion. HE ×50. Figure 5: Microscopic features of the resected uterus. The CIN3 component. CIN3 without invasion is seen. HE ×50. Figure 6: Immunohistochemical features. The adenocarcinoma component is strongly positive for cytokeratin 18. ×100. Figure 7: Immunohistochemical features. The adenocarcinoma component is strongly positive for CA125. ×100. Figure 8: Immunohistochemical features. The CIN3 component was strongly positive for cytokeratin 34βE12. ×100. Figure 9: Immunohistochemical features. The CIN3 component was strongly positive for p63. ×100. Figure 10: Immunohistochemical features. The CIN3 component was positive for MUC1. ×100.
Altmetric
References
  1. World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organsTumours of uterine cervixIARC press, LyonTavassoli FA and Devilee2003259311 Tumours of uterine cervix , 259-311 (2003) .
    • . . . Adenocarcinoma of the uterine cervix was classified into adenocarcinoma NOS, mucinous adenocarcinoma, endometrioid adenocarcinoma, clear cell adenocarcinoma, serous adenocarcinoma mesonephric adenocarcinoma, early microinvasive adenocarcinoma, and adenocarcinoma in situ 1 . . .
    • . . . The mucinous adenocarcinoma was subclassified into endocervical, intestinal, signet-ring cell, minimal deviation, and villoglandular subtypes 1 . . .
    • . . . Recently, they have been termed as cervical intraepithelial neoplasm (CIN) or squamous intraepithelial lesions (SIL) 1 . . .
    • . . . CIN is categorized as CIN 1-3, and SIL as low grade SIL (CIN 1) and high grade SIL(CIN2-3/CIS) (HGSIL) 1 . . .
    • . . . These lesions are known to be frequently associated with sexual intercourses and human papilloma virus (HPV) infection 1 . . . .
    • . . . According to WHO 1 , adenocarcinoma is associated with CIN in about 40% of cases . . .
    • . . . Therefore, the adenocarcinoma was EMEA 1 . . .
    • . . . The diagnosis of CIN 3 is apparent in the present case 1 . . . .
    • . . . The histological features fulfill the diagnosis of CIN 3 1 . . .
    • . . . The adenocarcinoma element in the present study was of EMEA negative for mucins 1 . . .
  2. JL Brown; M Wells Cervical glandular atypia associated with squamous intraepithelial neoplasm: a premalignant lesion? J Clin Pathol 39, 22-28 (1986) .
    • . . . However, Brown et al 2 reported that only 1 case of adenocarcinoma was found in 105 cases of CIN 3 . . .
    • . . . From the standpoint of CIN, Brown et al 2 reported that 16 cases of cervical glandular atypia and only 1 case adenocarcinoma in situ were found in 105 cases of CIN 3 . . .
  3. T Terada; M Kawaguchi; K Furukawa; Y Sekido; RY Osamura Minute mixed ductal-endocrine carcinoma of the pancreas with predominant intraductal growth Pathol Int 52, 740-746 (2002) .
    • . . . An immunohistochemical study was performed with the use of DAKO Envision method (Dako Corp., Glostrup, Denmark), as described previously 3 4 5 6 7 . . .
  4. T Terada; M Kawaguchi Primary clear cell adenocarcinoma of the peritoneum Tohoku J Exp Med 206, 271-275 (2005) .
    • . . . An immunohistochemical study was performed with the use of DAKO Envision method (Dako Corp., Glostrup, Denmark), as described previously 3 4 5 6 7 . . .
  5. T Terada; M Taniguchi Intraductal oncocytic papillary neoplasm of the liver Pathol Int 54, 116-123 (2004) .
    • . . . An immunohistochemical study was performed with the use of DAKO Envision method (Dako Corp., Glostrup, Denmark), as described previously 3 4 5 6 7 . . .
  6. T Terada; T Moriki Monolobar ductal plate malformation disease of the liver Pathol Int 60, 407-412 (2010) .
    • . . . An immunohistochemical study was performed with the use of DAKO Envision method (Dako Corp., Glostrup, Denmark), as described previously 3 4 5 6 7 . . .
  7. Terada TLarge cell neuroendocrine carcinoma with sarcomatous changes of the endometrium: a case report with immunohistochemical studies and molecular genetic study of KIT and PDGFRAPathol Res Pract201020642042510.1016/j.prp.2009.12.00820189318 Pathol Res Pract 206, 420-425 (2010) .
    • . . . An immunohistochemical study was performed with the use of DAKO Envision method (Dako Corp., Glostrup, Denmark), as described previously 3 4 5 6 7 . . .
  8. YC Choo; B Naylor Coexistance of squamous cell carcinoma and adenocarcinoma of the uterine cervix Gynecol Oncol 17, 168-174 (1984) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
  9. RC Maier; HJ Norris Coexistance of cervical intraepithelial neoplasm with primary adenocarcinoma of the endocervix Obstet Gynecol 56, 361-364 (1980) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
    • . . . From the standpoint of cervical adenocarcinoma, Maier and Norris 9 reported that 99 cases of CIN were detected in 230 cases of cervical adenocarcinoma . . .
    • . . . About half of such cases were CIN 2 or CIN 3 9 . . .
  10. T Terada Simultaneous squamous cell carcinoma in situ and adenocarcinoma in situ of the uterine cervix in a 36-year-old Japanese woman Arch Gynecol Obstet 281, 527-530 (2010) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
    • . . . There is only one report that there is an association of adenocarcinoma in situ and cervical squamous cell carcinoma 10 . . .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
    • . . . There have been few immunohistochemical studies in simultaneous squamous neoplasm and adenocarcinoma in the uterine cervix 10 . . .
  11. M Vasilijevic; B Stanimirovic; D Stanojevic; M Djukic; N Vasilijevic Primary double invasive cervical carcinoma, squamous cell carcinoma and adenocarcinoma: case report Eur J Gynecol Oncol 29, 411-413 (2008) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
  12. K Goto; Y Takeuchi; A Yakihara; F Kosigi Synchronous invasive squamous cell carcinoma and clear cell adenocarcinoma of the uterine cervix: a different human papillomavirus status Gynecol Oncol 97, 976-979 (2005) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
  13. AJ van Aspert-van Erp; FM Smedts; GP Vooijs Severe cervical glandular cell lesions with coexisting squamous cell lesions Cancer 25, 218-227 (2004) .
    • . . . Squamous cell carcinoma and adenocarcinoma can coexist in the uterine cervix 8 9 10 11 12 13 ; there are several case reports of this in the English literature 8 9 10 11 12 13 . . .
  14. P Anastasiadis; N Koutlaki; D Tamiolakis; V Liberis; G Galazios; E Sivridis Invasive adenocarcinoma of mixed endocervical and clear cell types, associated with invasive squamous cell carcinoma of the cervix uteri: a case report Eur J Gynecol Obstet 21, 173-176 (2000) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
  15. A Skopelitou; M Hadjiyannakis Enteric type villoglandular papillary adenocarcinoma of the uterine cervix associated with in situ squamous cell carcinoma: case report and review of the literature Eur J Gynecol Obstet 17, 309-314 (1996) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
  16. SC Lauchian; DW Penner Simultaneous adenocarcinoma in situ and epidermoid carcinoma in situ: report of two cases Cancer 20, 2250-2254 (1967) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
  17. BM Wolk; W Kime; V Albites Simultaneous in situ squamous cell carcinoma and microinvasive adenocarcinoma of the cervix Int J Gynecol Obstet 19, 69-72 (1981) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
    • . . . In addition, cases of simultaneous early microinvasive adenocarcinoma and CIN3 are very rare 17 18 . . .
  18. M Yamasaki; G Ueda; Y Sato; Y Kobayashi; K Kurachi Simultaneous squamous cell carcinoma in situ and early invasive adenocarcinoma of the uterine cervix Acta Obstet Gynecol Jpn 22, 6-9 (1975) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
    • . . . In addition, cases of simultaneous early microinvasive adenocarcinoma and CIN3 are very rare 17 18 . . .
  19. T Toki; Y Katayama; T Motoyama Small cell neuroendocrine carcinoma of the uterine cervix associated with microinvasive squamous cell carcinoma and adenocarcinoma in situ Pathol Int 46, 520-525 (1996) .
    • . . . However, cases of simultaneous adenocarcinoma and CIN3 are very rare in the English literature 10 14 15 16 17 18 19 . . .
  20. F Smedts; F Ramaekers; S Troyanovsky; M Pruszczynski; M Link; B Lane; I Leich; C Schijf Keratin expression in cervical cancer Am J Pathol 141, 497-511 (1992) .
    • . . . Since squamous lesions express high-molecular weight CK while adenocarcinoma low-molecular weight cytokeratin 20 , the present data indicate the CIN3 is squamous lesions and EMEA is adenocarcinoma . . .
  21. SR Owens; JK Greenson Immunohistochemical staining for p63 is useful in the diagnosis of anal squamous cell carcinomas Am J Surg Pathol 31, 285-290 (2007) .
    • . . . The presence of p63 in CIN3 but not in EMEA indicates that CIN3 was squamous lesion and EMEA is not, since p63 is known to be expressed in squamous lesions but not in adenocarcinoma lesions 21 . . .
Expand