A case of endocervical minimal deviation adenocarcinoma with varicolored cytopathologic features on Pap smear

• Published in: Diagnostic cytopathology 2018-08, Vol.46 (8), p.702-706
• Main Authors: Omori, Makiko, Kondo, Tetsuo, Nakazawa, Kumiko, Shinohara, Satoshi, Watanabe, Yumika, Fukasawa, Hiroko, Nakazawa, Tadao, Hashi, Akihiko, Hirata, Shuji
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - pathology; Case reports; Cervical cancer; Cervix; Chickens; Cytology; Cytoplasm; Deviation; Diagnosis, Differential; Female; gastric type; Glands; Honeycomb construction; Humans; Hyperplasia; lobular endocervical glandular hyperplasia; Middle Aged; minimal deviation adenocarcinoma; Mucin; Nuclei; Nuclei (cytology); Pap smear; Papanicolaou Test; Papillae; Poultry; Smear; Stroma; Uterine Cervical Neoplasms - pathology; Uterus; Vagina
• ISSN: 8755-1039; 1097-0339
• DOI: 10.1002/dc.23932

We report a case of minimal deviation adenocarcinoma (MDA) of the uterine cervix showing varicolored cytopathologic features on Papanicolaou (Pap) smear, which may indicate features suggestive of lobular endocervical glandular hyperplasia (LEGH)‐adenocarcinoma sequence. A 57‐year‐old woman presented with a profuse amount of watery vaginal discharge. Gynecological examination revealed a cervical mass with involvement of the right parametrium. Conventional Pap smear showed hypercellularity consisting of approximately 4 types of clusters as follows: (1) clusters showing a monolayered honeycomb sheet of endocervical cells with golden‐yellow mucin and bland nuclei, (2) three‐dimensional clusters showing varicolored mucin and irregular nuclear overlapping, (3) irregularly shaped clusters showing distorted chicken‐wire‐mesh appearance with noticeable protrusions of the nuclei and clear or faint varicolored cytoplasm, and (4) crowded clusters showing scarce mucin and nuclear atypia. The surgically resected uterus revealed LEGH‐mimicking lesion with fused papillae and a cribriform pattern in the endocervix and many glands exhibiting gastric differentiation that invaded deeper areas of the stroma with a subtle stromal reaction. Compared with histologic findings, two types of clusters, the crowded cluster with scarce mucin and the cluster with distorted chicken‐wire‐mesh‐type appearance, were considered as adenocarcinoma, and the latter was interpreted as a gastric‐type adenocarcinoma. Three‐dimensional varicolored type clusters showed atypical features, but insufficient atypical features compared with those of adenocarcinoma. Detection of clusters with varicolored mucin on conventional Pap smear may provide a clue for the early recognition of the malignant potential of LEGH on cytology. The chicken‐wire‐mesh type clusters may be a characteristic cytologic finding of MDA.