3.c.i Adenosquamous Carcinoma

Adenosquamous Carcinoma

Adenosquamous Carcinoma

Adenosquamous Carcinoma

Adenosquamous Carcinoma

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Invasive adenosquamous carcinoma is a biphasic variant of cervical carcinoma featuring both malignant squamous and glandular components. To render a diagnosis of adenosquamous carcinoma, it is necessary that both squamous and glandular elements be recognizable on routine H&E sections without requiring the use of special stains or immunohistochemistry. However, the morphological features can vary considerably from one case to another due to variation in the proportion, distribution and degree of differentiation of each component. In some cases, the squamous and glandular elements can be well individualised and adjacent to one another, whereas in other cases both elements can be closely intermingled and even blending. In some cases, the presence of intracytoplasmic mucin (visualised on H&E) in an otherwise poorly differentiated tumor will be the only evidence to establish the diagnosis. Such tumors may be easily misdiagnosed as large cell non-keratinising squamous cell carcinomas if care is not given to identify the glandular differentiation. Adenosquamous carcinomas should also be distinguished from endometrioid adenocarcinomas with squamous metaplasia in which the squamous component is benign.

Even though there is conflicting data regarding their behaviour, adenosquamous carcinomas are considered as high grade tumors and believed to be more aggressive than conventional cervical squamous cell carcinomas or adenocarcinomas. Glassy cell carcinoma is considered a poorly differentiated variant of adenosquamous carcinoma with distinctive morphologic features.

Adenosquamous carcinoma is an HPV induced neoplasm and it is therefore frequently associated with adenocarcinoma in situ and/or squamous intraepithelial lesion. However, the precise precursor of adenosquamous carcinoma remains uncertain; it has been hypothesized to be SMILE lesions because they share similar morphological features and because SMILEs have been described concomitantly with invasive adenosquamous carcinomas.