3.b.iv Endometrioid Adenocarcinoma

Endometrioid Adenocarcinoma

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Endocervical endometrioid adenocarcinoma is a subtype of endocervical adenocarcinoma with morphological features identical to endometrial endometrioid adenocarcinoma (LINK, endometrium atlas, endometrioid adenocarcinoma). Its diagnosis carries some subjectivity and the distinction between a true endocervical endometrioid adenocarcinoma and an endocervical adenocarcinoma with minimal amount of mucin is difficult. The distinction between them remains however academic because their management and prognosis are the same. The main difficulty is to establish the distinction between a primary endocervical endometrioid adenocarcinoma and secondary cervical involvement by endometrial endometrioid adenocarcinoma. On a hysterectomy specimen, the presence or absence of endometrial involvement should establish the diagnosis. On a biopsy specimen, immunohistochemistry may be helpful as an endocervical primary will have the same immunoprofile as a conventional endocervical adenocarcinoma (CEA+, ER-, PR-, vimentin-, p16+). It is however noteworthy that it is not that relevant to make this distinction on a biopsy specimen, because many surgeons may base their surgical treatment decision mainly on clinical grounds and may opt to perform a radical hysterectomy for either diagnosis. The presence of squamous metaplasia in endocervical endometrioid adenocarcinoma should alert the pathologist to exclude an endocervical adenosquamous carcinoma: adenosquamous carcinoma is a high grade malignancy with a worse prognosis in which the squamous component is malignant.