Hwang Inwoo, Lee Jiyeon, Choi Kyue-Hee, Han Jiheun, Kim Hyun-Soo
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Case Rep Oncol. 2020 Dec 22;13(3):1530-1536. doi: 10.1159/000511568. eCollection 2020 Sep-Dec.
Misdiagnosis of endocervical adenocarcinoma (EAC) as endometrial endometrioid carcinoma (EEC) is one of the major concerns when evaluating endometrial curettage specimens. It is difficult to differentiate EAC involving the endometrium from EEC, particularly when the specimens have only a few small tumor fragments. We report a case of endocervical adenocarcinoma (AIS) with multifocal microscopic involvement of the endometrium. The endometrial curettage specimen obtained from an 82-year-old woman consisted of a large volume of blood and fibrin, with small endometrial tissue fragments showing microscopic foci of atypical glandular proliferation. Based on the presence of complex glands with stratified mucin-poor columnar epithelium and intermediate-grade nuclear atypia, a preoperative diagnosis of grade 1 EEC was made. However, the hysterectomy specimen revealed an endocervical AIS involving the endocervix and low uterine segment. Frequent mitotic figures and apoptotic bodies, characteristic of AIS, were present. The endometrium showed a few microscopic foci of atypical glandular proliferation involving the surface only. Their histological features were similar to those of the endocervical AIS. Immunohistochemically, the atypical glands exhibited block p16 positivity. The final diagnosis was a superficially spreading endocervical AIS with multifocal microscopic involvement of the endometrial surface epithelium. In summary, small tumor tissues in an endometrial curettage may lead to misdiagnosis of AIS or EAC as EEC, especially when the pathologists are unaware of the possibility of microscopic endometrial involvement of AIS or EAC. The origin of the tumor can be correctly determined based on a combination of histological features and immunostaining. Endocervical AIS involving the endometrium should be included in the differential diagnosis of neoplastic glandular lesions in endometrial curettage specimens. An accurate diagnosis in these cases is important because of its significant implications for clinical management.
在评估子宫内膜刮宫标本时，将宫颈腺癌（EAC）误诊为子宫内膜样腺癌（EEC）是主要问题之一。区分累及子宫内膜的EAC与EEC很困难，尤其是当标本仅有少量小肿瘤碎片时。我们报告一例宫颈原位腺癌（AIS）伴子宫内膜多灶微小浸润病例。一名82岁女性的子宫内膜刮宫标本含有大量血液和纤维蛋白，少量子宫内膜组织碎片显示非典型腺体增生的微小病灶。基于存在具有分层、黏液少的柱状上皮和中级核异型性的复杂腺体，术前诊断为1级EEC。然而，子宫切除标本显示宫颈AIS累及宫颈和子宫下段。可见AIS特有的频繁有丝分裂象和凋亡小体。子宫内膜仅表面有少数非典型腺体增生的微小病灶。其组织学特征与宫颈AIS相似。免疫组化显示，非典型腺体呈p16阳性。最终诊断为浅表播散性宫颈AIS伴子宫内膜表面上皮多灶微小浸润。总之，子宫内膜刮宫术中的小肿瘤组织可能导致AIS或EAC被误诊为EEC，尤其是当病理医生未意识到AIS或EAC存在微小子宫内膜浸润的可能性时。结合组织学特征和免疫染色可正确确定肿瘤起源。子宫内膜刮宫标本中肿瘤性腺体病变的鉴别诊断应包括累及子宫内膜的宫颈AIS。这些病例的准确诊断很重要，因为对临床管理有重大意义。
