Analysis of gastric-type mucinous carcinoma of the uterine cervix — An aggressive tumor with a poor prognosis: A multi-institutional study

Abstract

GAS showed aggressive behavior with ominous histopathological predictors as well as decreased survival.• GAS also showed resistance to radiotherapy.• GAS is therefore considered a distinct entity that should be distinguished from UEA. a b s t r a c tObjective. Gastric-type mucinous carcinoma (GAS) is a novel variant of mucinous carcinoma of the uterine cervix. As shown in the original Japanese group description, in recent studies, GAS represents a more aggressive disease than the usual-type endocervical adenocarcinoma (UEA). Detailed clinicopathological features of this variant remain to be elucidated in a larger series of patients.Methods. Patients were enrolled by the Gynecologic Cancer Study Group of the Japan Clinical Oncology Group after receiving the approval of each Institutional Review Board. The study population comprised of women with stage I to II endocervical adenocarcinomas who underwent surgery between 2000 and 2009. Representative slides were evaluated by central pathological review (CPR), categorized into either GAS or UEA, and correlated with clinicopathological features and outcome.Results. Among the 393 enrolled patients with endocervical adenocarcinoma, 328 patients met the criteria for CPR and the study eligibility criteria and were included in further analysis. A total of 95 of the 328 tumors were classified as GAS. Compared with UEA, GAS was more significantly associated with bulky mass, deep stromal invasion, lymphovascular space invasion, parametrial invasion, ovarian metastasis, positive ascitic fluid cytology, j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / y g y n o pelvic lymph node metastasis, and pathological (p) T stage but was not related to the degree of histological differentiation. Disease-free survival (P b 0.0001) and overall survival (P b 0.0001) were poorer in patients with GAS than in those with UEA.Conclusions. GAS showed aggressive behavior with ominous histopathological predictors as well as decreased survival. GAS is therefore considered a distinct entity that should be distinguished from UEA.Clinical trial information. UMIN Clinical Trials Registry: UMIN000007987

Clinicopathological and Molecular Differences Between Gastric-type Mucinous Carcinoma and Usual-type Endocervical Adenocarcinoma of the Uterine Cervix

“…GMC frequently metastasizes to the extrapelvic organs and exhibits worse prognosis (24). Our results are consistent with those of a recent study by Nishio et al (25) with the largest GMC cohort, which ultimately demonstrated that GMC is more significantly associated with bulky mass, deep stromal invasion, and parametrial invasion than UEA. Our observations that all GMC cases classified as FIGO stage II-IV, but the majority (80.0%) of the UEA patients had FIGO stage I tumors is in accordance with those of Karamurzin et al (24), which showed that GMC presents at more advanced stages than UEA.…”

“…Our observations that all GMC cases classified as FIGO stage II-IV, but the majority (80.0%) of the UEA patients had FIGO stage I tumors is in accordance with those of Karamurzin et al (24), which showed that GMC presents at more advanced stages than UEA. Nishio et al (25) reported that lymphovascular invasion, ovarian metastasis, pelvic lymph node metastasis, and recurrence, all of which are conventional pathological features that predict worse prognosis, were more frequently observed in GMC compared to in UEA. However, a significant difference was not observed in the frequency of the lymphovascular invasion, adnexal extension, lymph node metastasis, and local recurrence between GMC and UEA.…”

Gastric‐type endocervical adenocarcinoma and cervical cytology: Experience at a general hospital and review of the literature

“…This article is protected by copyright. All rights reserved surgical sampling specimens [1][2][3] . The reported cytologic diagnostic features of GAS are subtle and include monolayered and honeycombed sheets of cells with vacuolar or foamy cytoplasm, vesicular nuclei with distinct nucleoli, and minimal to absent mitotic activity 4,5 .…”

Gastric‐type mucinous carcinoma of the cervix and its precursors – historical overview

“…It may be that the outcome of patients with endocervical adenocarcinoma is closely related to the incidence of GAS, because other NHPVAs, including clear cell carcinoma, are rare. Some studies have estimated that the incidence of GAS is higher in Japan, accounting for 25–30% of all endocervical adenocarcinomas, explaining the lower rate of detection of high‐risk HPV in this country. In contrast, GAS appears to be less frequent in western countries, and a recent European study based on the updated 2014 WHO classification reported an incidence of 1.5% (7/461) .…”