Department of Pathology, Box Hill Hospital, Melbourne, Vic, Australia.
Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
Pathology. 2018 Feb;50(2):122-133. doi: 10.1016/j.pathol.2017.09.009. Epub 2017 Dec 9.
Adenocarcinoma of the cervix is less common than squamous cell carcinoma, although its relative prevalence is increasing. Oncogenic (high-risk) human papillomavirus (HPV) infection is implicated in the development of approximately 90% of all cervical adenocarcinomas. Of the remaining non-HPV associated tumours, the most frequent is gastric-type adenocarcinoma (GAS), which is recognised by the World Health Organization as a form of mucinous adenocarcinoma of the cervix. Minimal deviation adenocarcinoma (MDA) of mucinous type (adenoma malignum) is considered an extremely well differentiated variant of GAS and is encompassed within the category of GAS. The concept of gastric-type cervical glandular lesions has emerged over recent decades and our understanding of the full spectrum of benign, premalignant and malignant lesions is still evolving. Established benign lesions, which are rare, include simple gastric metaplasia and lobular endocervical glandular hyperplasia (LEGH) (complex gastric metaplasia). Postulated premalignant lesions comprise atypical LEGH and gastric-type adenocarcinoma in situ (gAIS); these are probably related lesions for which the umbrella term 'gAIS' has been proposed. The term 'gastric-type' derives from the morphological resemblance of the glandular epithelium to that seen in the stomach and pancreaticobiliary tree; intestinal metaplasia with goblet cells and neuroendocrine cells are present in some cases. A gastric immunophenotype has been demonstrated using markers of pyloric gland mucin, MUC6 and HIK1083. Uncommonly, gastric-type cervical glandular lesions involve multiple sites in the female genital tract and it may be problematic to discern whether these represent independent synchronous or metastatic lesions. There is also an association between gastric-type cervical lesions and Peutz-Jeghers syndrome. Awareness of the spectrum of gastric-type lesions is important, as the diagnostic features of both gAIS and GAS, particularly well differentiated examples, may be subtle, and p16 immunohistochemistry is usually negative. GAS has a much poorer prognosis than HPV-associated cervical adenocarcinoma, with propensity for presentation at advanced stage and wide dissemination to unusual sites such as the ovary, omentum and peritoneum. Although uncommon, GAS is likely to increase in relative prevalence with the introduction of HPV vaccination and precursor lesions will not be detected by primary HPV-based screening programs.
宫颈腺癌比鳞状细胞癌少见，但相对发病率在增加。致癌（高危）型人乳头瘤病毒（HPV）感染与大约 90%的所有宫颈腺癌有关。在其他非 HPV 相关肿瘤中，最常见的是胃型腺癌（GAS），世界卫生组织将其视为宫颈黏液性腺癌的一种形式。低度恶性潜能的黏液性腺癌（MDA）被认为是 GAS 的一种高度分化变异体，属于 GAS 范畴。近几十年来，胃型宫颈腺性病变的概念已经出现，我们对良性、癌前病变和恶性病变的全面认识仍在不断发展。已确立的良性病变很少见，包括单纯性胃化生和宫颈管小叶内腺体增生（LEGH）（复杂胃化生）。推测的癌前病变包括不典型 LEGH 和胃型原位腺癌（gAIS）；这些可能是相关病变，因此提出了“gAIS”这一总称。“胃型”这个词来源于腺体上皮与胃和胰胆管树相似的形态学特征；在一些病例中，可见肠化生伴杯状细胞和神经内分泌细胞。使用幽门腺黏蛋白、MUC6 和 HIK1083 的标志物已经证明了胃型的免疫表型。宫颈胃型腺性病变罕见地累及女性生殖道的多个部位，难以确定这些病变是独立的、同步的还是转移性病变。胃型宫颈病变与 Peutz-Jeghers 综合征也有关联。了解胃型病变的范围很重要，因为 gAIS 和 GAS 的诊断特征，特别是分化良好的病例，可能不明显，p16 免疫组化通常为阴性。与 HPV 相关的宫颈腺癌相比，GAS 的预后要差得多，其表现为晚期，广泛播散至卵巢、网膜和腹膜等不常见部位。尽管少见，但随着 HPV 疫苗的引入，GAS 的相对发病率可能会增加，而初级 HPV 筛查计划不会发现其前驱病变。
