Adenoid Cystic Carcinoma of the Uterine Cervix: A Report of 2 Cases

Abstract

Adenoid cystic carcinoma is malignant tumor that exceptionally occurs in the uterine cervix. It is mostly seen in postmenopausal women and has an aggressive clinical course. We report two cases of an adenoid cystic carcinoma associated with a high grade squamous intraepithelial lesion and invasive squamous cell carcinoma of the uterine cervix and discuss briefly its clinical and pathological characteristics.

Adenoid Cystic Carcinoma of the Cervix: Case Report

“…In addition to this, other patterns can be described through examination, such as the tubular solid and undifferentiated pattern. The finding of areas of necrosis in the anatomopathological examination in our case, seems to be a common finding according to some authors [4] [7]. Lymphovascular invasion is also common in this type of tumor and was also detectable in our case.…”

“…On the basis of morphology, pleomorphism, mitotic index and stromal hyalinization of ACC, it is possible to distinguish it from small cell carcinoma, basal adenoid carcinoma and nonkeratinized squamous cell carcinoma, considered to be its main differential diagnoses. In addition, immunohistochemical examination of ACC reveals diffuse positivity for CD 117, cytokeratin and CAM 5.2 [7]. In the case reported, these differential pathologic aspects could be noted as described previously.…”

“…Although tumor etiopathogenesis remains uncertain, Shi et al[6] found 27 cases described in the literature of cervical ACC associated with cervical carcinomas, supporting the hypothesis that there is a common cellular origin and/or causative agent. Probably, the chronic HPV infection[6].In fact, some immunohistochemical evidence suggests that ACC develops from the multipotent basal cells of the cervical epithelium, which posterior squamous or glandular differentiation[7].Clinically, as reported in our case, this tumor is often manifested by continuous or irregular vaginal bleeding. It should be noted that the presence of constitutional symptoms reported by our patient, including substantial weight loss in recent months, contributes to the diagnostic suspicion of a malignant neoplasia.…”

“…Lymphovascular invasion is also common in this type of tumor and was also detectable in our case. This common fact in this type of tumor can contribute to a worsening in prognosis [7].…”

“…This recommendation is due to the fact that uterine cervix are considered radiosensitive tumors, and in previously reported cases, even in the early stages, better results were seen with adjuvant radiotherapy compared to surgical treatment alone[8]. The role of chemotherapy as adjunctive or primary treatment is still undefined, although in some case reports, chemotherapy has been indicated only for recurrent disease[7]. In our case, chemotherapy was used during radiotherapy.Elhassani et al reported 13 cases of cervical ACC stage IIIB, where the first case was managed with chemotherapy and concomitant radiotherapy, achieving success [4].…”