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Lee S, Lee HJ, Choi KU, Kwon BS, Suh DS, Jeong DH, Kim GJ, Lee TH, Roh HJ, Kim KH. The association between expression of p53 and aggressiveness of serous adenocarcinoma of the uterine cervix. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:47. [PMID: 32765617 PMCID: PMC7377125 DOI: 10.4103/jrms.jrms_788_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/22/2019] [Accepted: 02/16/2020] [Indexed: 11/05/2022]
Abstract
Background: Serous adenocarcinoma of the uterine cervix is an extremely rare variant of cervical adenocarcinoma. This study aimed to evaluate the clinicopathological and molecular features and outcomes of serous adenocarcinoma of the uterine cervix (SACC). Materials and Methods: This was a retrospective study conducted based on the clinical and pathological data of seven patients diagnosed with SACC after hysterectomy, who were evaluated at the gynecologic oncologic centers between 2010 and 2019. Results: Five cases were diagnosed at Stage IB and two at Stage IV. All patients underwent radical hysterectomy with bilateral salpingo-oophorectomy and subsequently received postoperative radiotherapy or chemotherapy. One patient showed persistent disease, and two patients suffered recurrence. Immunohistochemical study showed that three (43%) of the seven patients were positive for p53, and among these three patients, two with diffuse strong p53 expression experienced an aggressive course with recurrences at pelvic lymph nodes, lung, and brain. Conclusion: High p53 expression and advanced stage may be associated with poorer clinical outcomes in SACC, which suggest that immunohistochemistry may contribute to the prediction of prognosis.
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Affiliation(s)
- Sul Lee
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hyun Joo Lee
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kyung Un Choi
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.,Department of Pathology, School of Medicine, Pusan National University, Busan, South Korea
| | - Byung Su Kwon
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Geun Joo Kim
- Department of Obstetrics and Gynecology, College of Medicine, Kosin University Gospel Hospital, Kosin University, Busan, South Korea
| | - Tae Hwa Lee
- Department of Obstetrics and Gynecology, College of Medicine, Kosin University Gospel Hospital, Kosin University, Busan, South Korea
| | - Hyun-Jin Roh
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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2
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Kitade S, Ariyoshi K, Taguchi K, Maenohara S, Tomita Y, Sonoda K, Okadome M, Saito T. Serous carcinoma of the uterine cervix: Clinicopathological features differing from serous carcinomas of other female organs. J Obstet Gynaecol Res 2019; 46:153-160. [PMID: 31642140 PMCID: PMC7754289 DOI: 10.1111/jog.14142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/25/2019] [Indexed: 11/28/2022]
Abstract
Aim Serous carcinoma of the uterine cervix (USCC) is a very rare malignant tumor, while this histological subtype is common in the ovary, fallopian tube, uterine corpus and peritoneum. Because of its rarity, details of the clinicopathological features of USCC are largely unknown. We retrospectively analyzed the clinicopathological characteristics of five cases of pure USCC. Methods We reviewed the medical records and pathological specimens of five USCC cases who were treated at the Gynecology Service of the National Hospital Organization Kyushu Cancer Center, Japan, between 2000 and 2017. The clinicopathological features were also compared with those of serous carcinomas of the endometrium and ovary who were treated during the same period. Results Five patients were treated at our hospital between 2000 and 2017. Three tumors were stage IB1, one was stage IIB, and one was stage IVB. The median follow‐up time was 104 months (range 26–210). Four patients other than stage IVB were treated with radical hysterectomy and have been free of relapse. One patient with stage IVB tumor was treated with platinum‐based combination chemotherapy and is currently on maintenance therapy with bevacizumab and remains free of relapse. Conclusion USCC has a distinctive clinicopathological feature that differentiates it from serous carcinomas of other female organs. USCC had been thought to be a poor prognostic disease; however, it could be curable if it is not accompanied by lymph node metastasis or peritoneal dissemination. We might conquer USCC even if it is accompanied by lymph node metastasis with the use of multimodal therapy.
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Affiliation(s)
- Shoko Kitade
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuya Ariyoshi
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shoji Maenohara
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yui Tomita
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kenzo Sonoda
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masao Okadome
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Bisht N, Singh S, Purkayastha A, Shelly D, Bhandoria G, Mulajker D. Serous Papillary Carcinoma of Cervix: A Clinicopathological Dilemma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0273-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Gadducci A, Guerrieri ME, Cosio S. Adenocarcinoma of the uterine cervix: Pathologic features, treatment options, clinical outcome and prognostic variables. Crit Rev Oncol Hematol 2019; 135:103-114. [PMID: 30819439 DOI: 10.1016/j.critrevonc.2019.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022] Open
Abstract
Adenocarcinoma accounts for 10-25% of all cervical cancers, and its relative and absolute rate has raised over the past decades. Most, but not all the authors, reported that adenocarcinoma has a greater propensity to lymph node, ovarian and distant metastases and a worse prognosis compared with squamous cell carcinoma. However, whether histologic type is an independent prognostic factor is still a debated issue. Moreover, adenocarcinoma is a very heterogenous disease, including different histological subtypes. Whereas radical hysterectomy and definitive radiotherapy achieve the same clinical outcome in early stage squamous cell carcinoma, surgery seems to obtain better survival compared with definitive radiotherapy in early stage adenocarcinoma. Chemoradiation is the standard treatment for locally advanced cervical cancer regardless of histologic type, although several retrospective studies showed that patients with adenocarcinoma were more likely to die than those with squamous cell carcinoma both before and after concurrent chemoradiation era. The prognostic relevance of biological variables, such as cyclin-dependent kinase inhibitors, p53, cyclooxygenase-2 [COX-2], cell surface tyrosine-kinases and programmed death-ligand [PD-L1], is still under investigation. Palliative chemotherapy is the only treatment option for persistent or recurrent cervical adenocarcinoma not amenable with surgery and radiotherapy. The use of immune checkpoint inhibitors as well as a therapeutic strategy targeting cell surface tyrosine kinases should be adequately explored in this clinical setting.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
| | - Maria Elena Guerrieri
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
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5
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Tsuge S, Ueyama C, Watanabe K, Nakamura H, Takeda A. Microsatellite instability-high endocervical serous carcinoma manifesting as pulmonary thromboembolism: A case report and review of the literature. J Obstet Gynaecol Res 2018; 44:966-971. [PMID: 29436070 DOI: 10.1111/jog.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/31/2017] [Indexed: 11/29/2022]
Abstract
A 53-year-old obese woman was referred because of sudden onset of dyspnea and chronic vaginal bleeding. In addition to severe anemia, multiple pulmonary emboli were identified. Pelvic imaging showed an irregular-shaped mass in the region of the endocervix extending to the lower uterine segment. After successful anticoagulant therapy, followed by placement of an inferior vena cava filter, transabdominal hysterectomy and bilateral salpingo-oophorectomy were performed. An immunopathological study resulted in the diagnosis of endocervical serous carcinoma. After the identification of a high level of microsatellite instability (MSI), an immunohistochemical analysis of mismatch repair (MMR) proteins showed the isolated loss of PMS2. Germline testing of MMR genes showed no mutations, indicating that the high MSI had occurred as a result of sporadic isolated loss of the PMS2 gene expression.
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Affiliation(s)
- Shiori Tsuge
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Chikara Ueyama
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Kazuko Watanabe
- Department of Diagnostic Pathology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
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Jonska-Gmyrek J, Zolciak-Siwinska A, Gmyrek L, Michalski W, Poniatowska G, Fuksiewicz M, Wiechno P, Kucharz J, Kowalska M, Kotowicz B. Serous Carcinoma of the Uterine Cervix, an Extremely Rare Aggressive Entity: A Literature Review. Gynecol Obstet Invest 2018; 83:220-226. [PMID: 29393245 DOI: 10.1159/000486675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Serous carcinoma of the uterine cervix (USCC) is an extremely rare subtype. To establish the treatment strategy in patients with USCC is an important issue. METHODS MEDLINE (PubMed) was searched for all articles published after the first publication by Lurie et al. [Eur J Obstet Gynecol Reprod Biol 1991; 40: 79-81], reporting woman diagnosed with USCC. Because of limited numbers of studies on the topic of the study, we could not keep a restriction of eliminating smaller sample sizes. RESULTS A search of PubMed demonstrated that 113 cases of USCC have been reported in the literature since the first publication. The current treatment modality adopted for early cervical cancer is hysterectomy with bilateral iliac-obturator lymphadenectomy and postoperative radiotherapy (RT) or radiochemotherapy (RT-CT) if risk factors for cervical carcinoma appear. The treatment strategy for locally advanced USCC is preoperative RT-CT or chemotherapy (CHTH) with the intention to treat the patient surgically. The treatment option for disseminated disease is CHTH with paclitaxel and carboplatin. CONCLUSION Risk factors and a more advanced clinical stage of USCC have an impact on poor outcomes despite the use of standard treatment methods, adapted for cervical cancer. The outside-pelvic failures tend to seek effective systemic treatment.
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Affiliation(s)
- Joanna Jonska-Gmyrek
- Department of Radiotherapy, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland.,Department of Urooncology, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | | | | | - Wojciech Michalski
- Department of Urooncology, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Urooncology, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Malgorzata Fuksiewicz
- Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Pawel Wiechno
- Department of Urooncology, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Jakub Kucharz
- Department of Urooncology, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Maria Kowalska
- Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
| | - Beata Kotowicz
- Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Maria Sklodowska, Curie Institute, Oncology Center, Warsaw, Poland
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Stewart CJR, Koay MHE, Leslie C, Acott N, Leung YC. Cervical carcinomas with a micropapillary component: a clinicopathological study of eight cases. Histopathology 2017; 72:626-633. [PMID: 29034552 DOI: 10.1111/his.13419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
AIMS Micropapillary carcinomas, or carcinomas with a micropapillary component, are well recognised in the breast and other anatomical sites. However, they have seldom been described in the cervix. In this article, we present a clinicopathological analysis of eight cervical tumours that showed at least a focal (≥5%) component of micropapillary carcinoma. METHODS AND RESULTS The study group comprised eight cervical carcinomas (four adenocarcinomas and four adenosquamous carcinomas) with a micropapillary component. The median patient age was 41.5 years (range 27-65 years). At presentation, five patients were stage IB, two were stage IIB, and one was stage IV. The micropapillary component accounted for ≤25% of the tumour on initial biopsy or resection specimens in all but one case. Immunohistochemistry showed 'inside-out' (reverse polarity) mucin 1 staining along the cell membrane abutting the stroma. Four patients developed metastasis, all of whom showed a pure micropapillary pattern; this led to a misdiagnosis of an apparently independent peritoneal serous carcinoma in one case. All tumours showed diffuse p16 expression, and all three cases that were tested were positive for human papillomavirus (HPV) 18. Three of the six patients with at least 12 months of follow-up died of disease, and one is alive with distant metastasis. CONCLUSIONS Usual-type (HPV-related) cervical carcinomas may show micropapillary differentiation, usually as a focal finding, and the cells show reverse polarity like similar tumours arising in other sites. Micropapillary cervical carcinoma appears to be a clinically aggressive malignancy, although this needs to be confirmed in larger studies.
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Affiliation(s)
- Colin J R Stewart
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia.,School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Mei H E Koay
- Department of Pathology, King Edward Memorial Hospital, Perth, WA, Australia
| | - Connull Leslie
- Division of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Nathan Acott
- Division of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Yee C Leung
- School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.,Department of Gynaecological Oncology, King Edward Memorial Hospital, Perth, WA, Australia
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8
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Papillary serous carcinoma of the uterine cervix with lung metastasis. Case Rep Oncol Med 2014; 2014:683103. [PMID: 24716046 PMCID: PMC3970363 DOI: 10.1155/2014/683103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/22/2014] [Indexed: 11/17/2022] Open
Abstract
Papillary serous carcinoma of the uterine cervix is a rare histological variant of cervical adenocarcinoma, with a very small number of cases reported. It is an aggressive tumor and is usually diagnosed at advanced stages by the time of diagnosis. Early-stage tumors can be treated with surgery and/or radiotherapy, while late-stage tumors have been treated with chemotherapy plus radical surgery with intermittent success. Here we report a case of metastatic papillary serous carcinoma observed at our hospital, which has been treated with debulking surgery and combination chemotherapy with carboplatin and paclitaxel.
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9
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Tang W, Zhang Z, Yao H, Zeng Z, Wan G. Papillary serous carcinoma of the cervix mixed with squamous cells: A report of the first case. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 6:22-4. [PMID: 24371711 PMCID: PMC3862309 DOI: 10.1016/j.gynor.2013.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Abstract
Objective Primary papillary serous carcinoma (PPSC) of the cervix is rarely recognized, with the aggressive and unpredictable course. Here we report a case of primary adenosquamous papillary serous carcinoma of the cervix in a woman who underwent comprehensive treatment. Case A 53-year-old woman presented with irregular vaginal bleeding in hospital. The patient with a diagnosis of PPSC by an intracolposcopic biopsy received radical hysterectomy with bilateral salpingo-oophorectomy, right pelvic lymphadenectomy, left pelvic lymph node dissection, and postoperative concurrent chemoradiotherapy. Postoperative immunohistochemistry showed that CK5/6, CK7, P16, CEA, CA12-5 and P53 were positive. During 17 months after operation, the patient demonstrated distant metastases of lymph nodes and finally died of brain metastasis. Conclusions Papillary serous adenocarcinoma of the cervix mixed with squamous cell carcinoma has not been reported since now, and here, this is the first documented case. Despite surgery and concurrent chemoradiotherapy, which were reported as effective therapeutic strategies for papillary serous adenocarcinoma of the cervix, the patient showed a poorer prognosis. Taken together, papillary serous adenosquamous carcinoma of the cervix could be more malignant than pure papillary serous adenocarcinoma. Papillary serous adenosquamous carcinoma of the cervix is firstly documented here. Surgery and postoperative chemoradiotherapy showed a poorer prognosis in the patient. Mixed adenosquamous carcinoma of the cervix behaves more aggressively .
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Affiliation(s)
- Weiwei Tang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100 Hongshan Road, Nanjing 210028, China
| | - Zhenzhen Zhang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100 Hongshan Road, Nanjing 210028, China
| | - Hongmei Yao
- Department of Gynecology and Obstetrics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100 Hongshan Road, Nanjing 210028, China
| | - Zheng Zeng
- Department of Pathology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100 Hongshan Road, Nanjing 210028, China
| | - Guiping Wan
- Department of Gynecology and Obstetrics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100 Hongshan Road, Nanjing 210028, China
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