Clinicopathologic characteristics and outcome of gastric-type endocervical adenocarcinoma: a single-center retrospective study.

Abstract

Background: This study investigated the clinical and pathological characteristics of gastric-type endocervical adenocarcinoma (G-EAC) to advance the early diagnosis and treatment of this disease.

Methods: The diagnosis, treatment, follow-up, pathological morphology, immunohistochemical characteristics and other data of 15 patients of G-EAC visiting our hospital from December 2016 to March 2024 were retrospectively analyzed, and the relevant literature was discussed.

Results: The mean age of participants was 45.13 years. There were four cases with vaginal discharge, eight cases with spontaneous vaginal contact bleeding, one case where hysterosalpingography (HSG) demonstrated uterine cavity fluid accumulation, and two cases of abdominal pain and swelling with pelvic mass (one with fever) as the initial symptom. There were two participants with Peutz-Jeghers syndrome (PJS). Histologically speaking, G-EAC exhibited various morphologic characteristics, including well-differentiated glands and unusual glands dispersed randomly within the cervical stroma and lacking lobular structures. Neutrophil infiltration and glandular abscess formation were commonly observed. Immunohistochemical analysis showed no expression of ER, PR, or NapsinA, but varying degrees of CK7, MUC6, MUC5AC, CEA, HNF1β, and PAX-8 expression. During the follow-up, which lasted from 1 to 88 months, 2 participants died after 6 months and 10 months respectively. Moreover, 5 participants exhibited distant metastasis, and the remaining 8 participants were healthy and disease free.

Conclusion: G-EAC is an uncommon subtype of cervical adenocarcinoma that frequently manifests as an advanced-stage cancer with vague clinical symptoms, making biopsy-based diagnosis challenging. Since conventional treatments demonstrated limited efficacy, clinicians and pathologists should pay particular attention to this entity.