2024 Volume 63 Issue 3 Pages 140-144
Background : Gastric-type adenocarcinomas of the uterine cervix are usually already advanced at presentation and carry a poor prognosis. Herein, we report a case of endocervical gastric-type adenocarcinoma with a polypoid configuration that was diagnosed in the early stage.
Case : A woman in her 60s was detected as having a uterine cervical polyp. Cytological examination of the polyp showed sheet-like clusters of cells containing abundant clear cytoplasm with distinct nucleoli within the nuclei. There were also cellular clusters showing anisonucleosis and prominent mitoses, as well as peripheral palisading strips of tall columnar cells with eccentric nuclei. Histopathological examination of cervical polypectomy specimens revealed features consistent with well-differentiated gastric-type adenocarcinoma, characterized by a proliferation of cells with clear cytoplasm and basally oriented nuclei. A poorly differentiated, gastric-type adenocarcinoma component characterized by foamy cytoplasm and marked nuclear atypia was also found. Goblet cells were present in a small area of the polyp, indicative of focal intestinal differentiation. Immunohistochemically, the tumor cells showed positive staining for MUC6, CK7, MUC5AC, CDX2, MUC2 and CK20 (the latter two were focally positive), but negative staining for estrogen receptor, WT-1, p53, and p16. The Ki67 labeling index ranged from 1% to 55%. No evidence of residual cancer was apparent in the specimens collected from additional cervical conization followed by total hysterectomy (final diagnosis as FIGO stage ⅠA). There was no recurrence or metastasis of the cervical cancer until the 5-year follow-up after hysterectomy.
Conclusion : It is crucial to consider a diagnosis of gastric-type adenocarcinoma when atypical cervical cells are found in cervical cytological specimens, as in the present case.
