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Invasive Endocervical Adenocarcinoma

A New Pattern-based Classification System With Important Clinical Significance

Roma, Andres A. MD*; Diaz De Vivar, Andrea MD; Park, Kay J. MD; Alvarado-Cabrero, Isabel MD§; Rasty, Golnar MD; Chanona-Vilchis, Jose G. MD; Mikami, Yoshiki MD#; Hong, Sung R. MD**; Teramoto, Norihiro MD††; Ali-Fehmi, Rouba MD‡‡; Rutgers, Joanne K.L. MD§§; Barbuto, Denise MD§§; Silva, Elvio G. MD§§,∥∥

The American Journal of Surgical Pathology: May 2015 - Volume 39 - Issue 5 - p 667–672
doi: 10.1097/PAS.0000000000000402
Original Articles

A new 3-tier pattern-based system to classify endocervical adenocarcinoma was recently presented. In short, pattern A tumors were characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture. Pattern B tumors demonstrated localized destructive invasion defined as desmoplastic stroma surrounding glands with irregular and/or ill-defined borders or incomplete glands and associated tumor cells (individual or small clusters) within the stroma. Tumors with pattern C showed diffusely infiltrative glands with associated extensive desmoplastic response. In total, 352 cases (all FIGO stages) from 12 institutions were identified. Mean patient age was 45 years (range, 20 to 83 y). Forty-nine (13.9%) cases demonstrated lymph nodes (LNs) with metastatic endocervical carcinoma. Using this new system, 73 patients (20.7%) were identified with pattern A tumors (all stage I); none had LN metastases and/or recurrences. Ninety patients (25.6%) were identified with pattern B tumors (all stage I); only 4 (4.4%) had LN metastases; 1 had vaginal recurrence. The 189 (53.7%) remaining patients had pattern C tumors; 45 (23.8%) of them had LN metastases. This new classification system demonstrated 20.7% of patients (pattern A) with negative LNs, and patients with pattern A tumors can be spared of lymphadenectomy. Patients with pattern B tumors rarely presented with metastatic LNs, and sentinel LN examination could potentially identify these patients. Aggressive treatment is justified in patients with pattern C tumors.

*Cleveland Clinic, Cleveland, OH

Baylor College of Medicine, Texas Children’s Hospital Pavilion for Women

∥∥The University of Texas MD Anderson Cancer Center, Houston, TX

Memorial Sloan Kettering Cancer Center, New York, NY

‡‡Department of Pathology, Wayne State University, Detroit, MI

§§Cedars-Sinai Medical Center, Los Angeles, CA

§Mexican Oncology Hospital, Mexico City, Mexico

Instituto Nacional de Cancerologia (Mexico), Mexico City, Mexico

University Health Network, University of Toronto, Toronto, ON

#Kyoto University Hospital, Kyoto

††Shikoku Cancer Center, Matsuyama, Japan

**Cheil General Hospital & Women’s Healthcare Center, Kwandong University, Gangneung, Korea

Conflicts of Interest and Source of Funding: Sponsored by the International Society of Gynecological Pathologists and Cedars Sinai Medical Center, Los Angeles, CA. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Andres A. Roma, MD, 9500 Euclid Ave, L2, Cleveland, OH 44122 (e-mail:

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.