Clinicopathologic Features of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix

  Objective  To explore the clinicopathologic features, diagnostic criteria, and prognostic factors of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix.

  Methods  We retrospectively analyzed the clinical and pathological data of 10 VGPA patients including age, clinical stage, surgical procedure, outcome, macroscopic features, tumor size, horizontal spread and depth of endophytic tumor, nuclear atypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis.

  Results  The median age was 39 years. Eight patients were at stage FIGO Ib1, one at stage IIa, and one at stage Ia1. All patients who had undergone hysterectomy and lymphadenectomy were alive, one patient experienced recurrence, and one patient was lost to the follow-up. Macroscopically, 5 cases showed exophytic polypoid or florid lesions with the diameter ranged between 5-25 mm, 3 cases showed microvillous rough regions with area ranged between 25 mm×14 mm-35 mm×20 mm, and the recurrent case showed an ulcerative type of mass with the diameter of 25 mm. Horizontal spread and depth of endophytic tumor ranged between 5 -26 mm and between 2 -12 mm, respectively; the invasion of posterior fornix of vagina was observed in one case. All the non-recurrent cases showed mild to moderate cytologic atypia, while the recurrent one showed severe cytologic atypia. The mean mitotic count was 48/10 HPF. Cervical intraepithelial neoplasia (CIN) Ⅲ and/or acute coronary ischemia syndrome (ACIS) or a mixture of the two were found in 9 cases, 2 of which were simultaneously in association with welldifferentiated adenocarcinoma. Occasional lymph capillary space invasion was present in one case. None had corpus infiltration, bulky lymph node metastases, or ovary metastasis.

  Conclusions  VGPA usually has a favorable prognosis. Predictors of a poor outcome include tumor infiltration of outer one-third cervical wall, corpus infiltration, vascular invasion, and positive lymph nodes; meanwhile, severe cytologic atypia and/or any other more aggressive malignant tumor can also play a role.