Cervix

Other epithelial tumors

Adenosquamous carcinoma



Last author update: 3 December 2007
Last staff update: 28 February 2023

Copyright: 2007-2024, PathologyOutlines.com, Inc.

PubMed Search: Adenosquamous carcinoma cervix

Branko Perunovic, D.M.
Ryan W. Askeland, M.D.
Cite this page: Perunovic B., Sunassee A, Askeland R. Adenosquamous carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixadenosquamous.html. Accessed December 24th, 2024.
Definition / general
Epidemiology
  • Glassy cell carcinoma:
    • Younger age group (mean 41 years), associated with pregnancy, HPV 16 and 18 in tumor cells (Cytojournal 2013;10:17)
    • Peak incidence third to fourth decades (Cytojournal 2013;10:17)
    • Some studies have noted an association with pregnancy
Pathophysiology
Etiology
Clinical features
  • Same prognosis as other cervical carcinomas when stratified by grade and stage but most cases are high grade
  • Glassy cell carcinoma:
    • 1 - 2% of cervical carcinomas
    • Historically considered more aggressive with poorer prognosis than ordinary adenosquamous carcinoma or adenocarcinoma, although recent studies show less or no difference (APMIS Suppl 1991;23:119, Am J Obstet Gynecol 2004;190:67)
    • May have peripheral blood eosinophilia
Prognostic factors
  • Glassy cell carcinoma has poor prognostic factors
    • Angiolymphatic invasion, deep stromal invasion, large tumor size
    • HER2 overexpression may correlate with more aggressive behavior and worse clinical outcome (Acta Cytol 2006;50:418)
Case reports
Treatment
  • Radical hysterectomy and chemoradiation
  • Cisplatin based chemoradiation: overall survival now comparable to squamous cell carcinoma of cervix, although historically poorer prognosis
  • Poorer prognosis with radiation alone (Gynecol Oncol 2014;135:208, Gynecol Oncol 2014;135:462)
Gross description
Gross images

AFIP images

Bulky exophytic mass

Microscopic (histologic) description
  • Usually defined as biphasic pattern of well defined malignant glandular and squamous components clearly identifiable without special stains
  • Glandular component usually endocervical and poorly differentiated with cytoplasmic vacuoles or luminal mucin
  • Squamous component also is poorly differentiated
  • If endometrioid call endometrioid carcinoma with squamous differentiation
  • Glassy cell carcinoma:
    • Solid nests of markedly pleomorphic, polygonal tumor cells with prominent cell membrane, glassy and eosinophilic cytoplasm, large eosinophilic nuclei, prominent nucleoli, surrounded by heavy inflammatory infiltrate containing eosinophils
    • Frequent mitotic figures
    • Pure cases have no histologic evidence of glandular or squamous differentiation (i.e. no intracellular bridges, no dyskeratosis, no intracellular glycogen), which is detectable only by electron microscopy
    • Often less invasion than is suspected
Microscopic (histologic) images

AFIP images

Poorly formed glands and squamous components

Sheets of cells with abundant lightly stained cytoplasm

Distinct cell border and prominent nucleoli

Cytology description
  • Often not diagnosed on pap smear (Cancer Cytopathology 2004;102:210)
  • Papillary subtype (thin layer cytology):
    • High cellularity
    • Multiple small, papillary clusters of basaloid to columnar cells
    • Discernible fibrovascular cores
    • Background of loosely dispersed bland looking columnar cells and high grade squamous intraepithelial lesion
    • Scattered adenocarcinoma cells containing intracytoplasmic vacuoles (Acta Cytol 2003;47:649)
  • Glassy cell carcinoma:
    • Tumor cells arranged in sheets or clusters
    • Distinct cell borders with moderate to abundant finely granular (ground glass-like) cytoplasm
    • Large round/oval vesicular nuclei with one or more prominent nucleoli
    • Chromatin varies from finely dispersed to coarse and irregular (Acta Cytol 2004;48:99, Zhonghua Bing Li Xue Za Zhi 2011;40:523)
    • Cytoplasmic vacuolization and bizarre cells with multinucleation may be seen (Acta Cytol 2001;45:407)
    • Mitotic figures frequently seen
    • Background inflammatory infiltrate including frequent eosinophils, neutrophils, plasma cells, lymphocytes and necrotic debris
    • Focal abortive keratin production; squamous or glandular differentiation may be present
    • Focal clear cell differentiation may be present
Cytology images

Images hosted on other servers:
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Abundant granular cytoplasm

Positive stains
Negative stains
Electron microscopy description
  • Glandular features include mucous secretory vacuoles, true lumen formation and scattered glycogen
  • Tonofilaments and secretory products
  • Note: most undifferentiated cervical carcinomas have ultrastructural features of squamous or glandular differentiation
  • Glassy cell carcinoma:
      • Glassy features may be due to cytoplasmic polyribosomes, abundant tonofilaments and abundant dilated rough endoplasmic reticulum (Am J Clin Pathol 1991;96:520)
      • Adenosquamous features include well developed desmosomal complexes and microvilli
      • Occasional intracellular lumina (Cancer 1983;51:2255)
Differential diagnosis
Additional references
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