Ciliated cell variant of endometrioid adenocarcinoma: a rare tumour

Ciliated Cell Variant of Endometrial Carcinoma in an Adenomyoma in Uterus

Ciliated cell variant of endometrioid adenocarcinoma (CCVEA) is an extremely rare tumor that has been seldom reported in the literature as low-grade endometrioid carcinoma with a favorable prognosis. CCVEA is characterized by neoplastic glands composed predominantly of ciliated cells with relatively little nuclear atypia. Recognition of the ciliated component is the key to the diagnosis of CCVEA but it can lead to diagnostic confusion with tubal metaplasia especially on endometrial biopsies. Herein, we report the case of a 56-year-old woman who presented with post-menopausal vaginal bleeding. Endometrial biopsy revealed extensive atypical complex endometrial hyperplasia composed predominantly of ciliated cells. The patient subsequently had a hysterectomy and bilateral salpingo-oophorectomy that revealed a large adenomyoma, adherent to the right ovary. The adenomyoma was extensively involved by CCVEA with some extension to the endometrial cavity. To the best of our knowledge, this is the first report of CCVEA that appears to arise in an adenomyoma.

Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section

Oropharyngeal squamous cell carcinomas associated with high risk HPV show a wide morphological spectrum, including papillary, adenosquamous, lymphoepithelioma-like and sarcomatoid. We report an interesting case of ciliated HPV-related carcinoma arising from tonsillar tissue in a 55-year-old man which was associated with HPV33. This rare variant has been described in only a handful of cases in the literature, and to our knowledge this is the first case specifically associated with HPV33. The presence of cilia is a potential diagnostic problem as it has been traditionally considered a feature of benignancy, and could pose a particular challenge on frozen section. The diagnostic challenges, differential diagnosis of this tumor and the association with HPV33 are discussed.

Ciliated HPV-related Carcinoma: A Well-differentiated Form of Head and Neck Carcinoma That Can Be Mistaken for a Benign Cyst

Although human papillomavirus (HPV)-related oropharyngeal carcinomas (HPV-OPCs) are generally regarded as "poorly differentiated," they actually maintain a close resemblance to the lymphoepithelium of the tonsillar crypts from which they arise: they are basaloid, exhibit minimal keratinization, and are often permeated by lymphocytes. In rare cases, the presence of cilia in a primary HPV-OPC and their persistence in lymph node metastasis can confound the distinction between a benign and malignant process. Three cases of ciliated HPV-OPCs were identified from the archives of The Johns Hopkins Head and Neck Pathology consultation service. HPV status was determined using p16 immunohistochemistry and high-risk HPV in situ hybridization. All 3 patients presented with a cystic lymph node metastasis without a known primary carcinoma. One metastasis was originally diagnosed as a branchial cleft cyst only to regionally recur 7 years later. In 2 cases, a primary HPV-OPC was found in the tonsil. The carcinomas exhibited both nonkeratinizing squamous epithelium and cystic/microcystic spaces lined by ciliated columnar cells. Both the squamous and ciliated cells were HPV positive. This report draws attention to a novel variant of HPV-related head and neck cancer that exhibits ciliated columnar cells. This variant challenges prevailing notions that: (1) HPV-OPCs are uniformly poorly differentiated cancers; (2) cilia are an infallible feature of benignancy; and (3) presence of cilia is a reliable criterion for establishing branchial cleft origin when dealing with cystic lesions of the lateral neck.