Adenosquamous Carcinoma of the Uterine Cervix – Impact of Histology on Clinical Management

Abstract

Introduction Historically, the incidence rate of cervical cancer (CC) in Eastern Europe and particularly in Bulgaria has constantly been higher than that in the other European countries. Adenosquamous carcinoma (ASC) is a rare histological subtype of CC with incidence rate of less than 6 per 100,000. We aimed to analyze the epidemiology and prognosis of all Bulgarian patients with ASC, registered at the Bulgarian National Cancer Registry (BNCR), and to compare patients’ characteristics and outcomes with those of patients, treated at a large specialized institution – the Department of Gynecologic Oncology, University Hospital in Pleven, Bulgaria. Materials and Methods This is a retrospective study of all cases of ASC, registered at the BNCR for a 10-year period of time. The Kaplan–Meier analysis with Log rank test was used to estimate the significant differences. Results The incidence rate of ASC was calculated as 3.2% of all CC registered in BNCR and 4.97% of all stage I patients, treated in our department. The 5-year overall survival (OS) rate of all patients with ASC tumors from the registry was 50.5%. A total of 171 (48.4%) of the patients had T1 tumors and a 5-year OS of 67.1%. Lymph node status was a significant prognostic factor for OS (p=0.001). Thirty-one patients with T1 tumors and ASC histology were treated in our department for the same period of time. Lymph node metastases were found in 10 of them (32.2%). The 5-year observed OS in ASC group was 74.19%. Conclusion The histological subtype of cancer of the uterine cervix has an impact on prognosis and should not be simply considered as a descriptive characteristic but a poor prognostic feature and should be an integral part of the decision-making in clinical management of patients.

Gene Expression Analysis for Uterine Cervix and Corpus Cancer Characterization

“…Nevertheless, according to Stolnicu et al, in practice, diagnoses of this subtype are frequently made erroneously in tumors lacking unequivocal squamous and/or glandular differentiation [ 39 ]. A recent analysis of the morphology of this subtype revealed that, in 42% of cases initially diagnosed as adenosquamous carcinoma, a reclassification was necessary [ 9 ]. Thus, the observed pattern in our results, instead of providing insights for the characterization of cervical adenosquamous carcinoma, may suggest the need to reconsider the diagnosis of these six mixed samples, which appear to resemble dedifferentiated cervical tumors.…”

“…In comparison to cervical squamous cell carcinoma, cervical adenocarcinoma exhibits greater aggressiveness, a higher rate of metastasis, inferior prognosis, and reduced rates of survival [ 8 ]. Cervical adenosquamous carcinoma is an infrequent subtype (with an incidence rate of less than 6/100,000 [ 9 ]) that is characterized by the presence of both squamous cell and glandular differentiation [ 10 ]. Few reports, often inconsistent, have documented the survival outcomes and prognostic factors in patients with this histological subtype [ 10 ].…”

Incidence and risk factors for the development of cerebral metastasis in cervical cancer patients

“…The frequency of adenosquamous carcinoma ranges from 3% to 10% [ 20 ], although some series may overestimate this diagnosis, as adenocarcinomas, alongside squamous metaplasia and mucus-secreting adenocarcinomas, can mimic adenosquamous carcinoma. In the present study, the frequency of adenosquamous carcinoma was 3.1%, similar to the rate described by Yordanov et al [ 20 ] in Bulgaria, of 3.2%. Adenosquamous carcinoma increased the risk of CM development by 7.3-fold (95% CI=2.87–18.73).…”

Adenosquamous Carcinoma of the Cervix - An Incidental Finding in the Hysterectomy Specimen of a Postmenopausal Female

“…Association with Human Papilloma Virus types 16 and 18 is seen frequently [4][5][6][7][8][9][10][11]. A monoclonal origin of ASCC has been confirmed and is thought to arise from subcolumnar reserve cells in the basal layer of endocervix [12].…”

“…The diagnosis of ASCC requires the identification of unequivocal malignant glandular and squamous differentiation in the tumor [6,7]. This rare subtype of cervical carcinoma is an aggressive tumor and has a worse prognosis as compared to squamous cell carcinoma [8].…”