Department of Anatomic Pathology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
Department of Anatomic Pathology, University of California, San Francisco, California, USA.
Cytopathology. 2021 Jan;32(1):75-83. doi: 10.1111/cyt.12907. Epub 2020 Oct 5.
Gastric-type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. This diagnosis is relatively rare and may portend a worse prognosis than usual-type endocervical adenocarcinoma. Subtle morphological features make it an under-recognised diagnostic challenge. Study of the cytological features of individual cases is valuable in order to increase awareness of this entity.
The pathology database of our institution was searched for the diagnosis of GAS and all cytological and surgical specimens for each patient were reviewed. The original cytological interpretation was compared to a retrospective central review interpretation. Clinical history and follow-up results were obtained from the electronic medical record.
Four cases of GAS were identified. The findings on initial cervical cytology varied, with GAS found in both patients with negative cervical cytology and those with atypical glandular cells. Cytological findings included endocervical cells arranged in three-dimensional clusters and honeycomb sheets with abundant vacuolar cytoplasm, and in two patients, moderate nuclear atypia with irregular nuclear membranes, coarse chromatin, hyperchromatic nuclei, and prominent nucleoli. In one patient, GAS was incidentally discovered via thorough sampling of a cystic lesion in the superior portion of the endocervical canal.
GAS is an aggressive human papillomavirus-independent type of endocervical adenocarcinoma with subtle morphological features and, as our study shows, varying clinical presentation. Given the aggressive nature of GAS and the difficulties in initial diagnosis, increased awareness of this entity among pathologists is crucial.
胃型宫颈内膜腺癌（GAS）是一种不常见的宫颈内膜腺癌，与人类乳头瘤病毒感染无关。这种诊断相对较少见，可能预示着比普通型宫颈内膜腺癌更差的预后。其细微的形态特征使其成为一种识别困难的诊断挑战。研究个别病例的细胞学特征对于提高对该实体的认识是有价值的。
我们机构的病理学数据库中搜索了 GAS 的诊断，对每位患者的所有细胞学和手术标本进行了复习。将原始细胞学解释与回顾性中央审查解释进行了比较。从电子病历中获得了临床病史和随访结果。
发现了 4 例 GAS。初始宫颈细胞学检查的结果各不相同，GAS 存在于阴性宫颈细胞学和非典型腺细胞的患者中。细胞学表现包括呈三维簇状和蜂窝状排列的宫颈内膜细胞，伴有丰富的空泡状细胞质，在 2 例患者中，核异型性中度，核膜不规则，染色质粗糙，核深染，核仁明显。在 1 例患者中，GAS 是通过对宫颈管上部囊性病变的彻底取样偶然发现的。
GAS 是一种侵袭性的、人乳头瘤病毒无关的宫颈内膜腺癌，具有细微的形态特征，如我们的研究所示，临床表现也各不相同。鉴于 GAS 的侵袭性和初始诊断的困难，病理学家对该实体的认识增加至关重要。
