A Retrospective Study and Literature Review of Cervical Villoglandular Adenocarcinoma: A Candidate Paradigm of Silva System Pattern A

Abstract

The aim was to investigate the clinicopathologic characters of cervical villoglandular adenocarcinoma (VGA), the authors retrospectively reviewed 4 cases of VGA, including clinical characteristics, pathology, managements, together with outcome information. The median age of the patients was 42 (range: 37 to 58), with 3 of them presenting with stage IB disease and 1 presenting with IVB. Human papillomavirus infection was tested in 3 of the patients, with all positive with high-risk type. Three of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, and 2 of them underwent subsequent chemotherapy. One patient received a bilateral salpingo-oophorectomy plus pelvic and periaortic lymphadenectomy and postoperative radiochemotherapy. Lymph node metastasis was detected in 1 patient. The follow-up time ranged from 56 to 120 months (median: 70 mo). Except for 1 person who experienced recurrence, all patients are alive at present and no recurrence occurred. In conclusion, VGA is a rare subtype of adenocarcinoma of the uterine cervix with distinct exophytic, villous-papillary growth pattern and extremely excellent prognosis, which corresponds with pattern A in Silva system, while its underlying mechanism and genetic background is still far from well known.

PD-L1 Expression and Silva Invasion Pattern in Villoglandular Adenocarcinoma of the Uterine Cervix

“…The Silva classification system categorizes endocervical adenocarcinomas into 3 patterns according to indicators of invasion; these patterns predict the risk of lymph node involvement more accurately than clinical stage and were developed to avoid unnecessary surgical morbidity for low-risk patients, irrespective of stage. Since VGA has a very favorable prognosis, one would expect a Silva pattern A in almost all cases (31). Pattern A cervical adenocarcinomas have no risk of lymph node metastases and a negligible risk of recurrence or cancer-related mortality (11).…”

“…Since the application of the Silva system has not yet been reported in the rare histopathological subtype VGA, we evaluated the feasibility and relevance of this system and correlated it to clinicopathological findings and outcomes. According to the Silva classification, (31,32) the exophytic portion of VGA should not be classified as a pattern C, even with a complex growth pattern, if invasion at the interface with the underlying cervical wall is nondestructive. Because of the nondestructive invasion, it would be a pattern A tumor.…”