Uterine Glandular Carcinoma

Abstract

This study correlated the histologic and immunohistochemical features of cervical and endometrial glandular carcinomas (adenosquamous carcinoma [ADENSQ] and ade nocarcinoma [AC] ) with clinical outcome. A series of 87 uterine glandular carcinomas (53 cervical, 33 endometrial, and 1 arising in both cervix and endometrium) were histologically classified into mullerian subtypes: 28 ADENSQ, 19 serous AC, 19 mu cinous AC, 15 endometrioid AC, and 6 clear cell AC. Utilizing both nuclear and archi tectural features, 66 glandular carcinomas were high histologic grade (3) and 21 were low histologic grade (1 or 2). Immunohistochemical studies performed on 83 of the cases showed: 33 + for monoclonal carcinoembryonic antigen (CEA-M); 38 + for polyclonal CEA (CEA-P); 26 + for placental alkaline phosphatase; 18 + for CA 125; 29 + for CA 19-9; 24 + for vimentin; 60 + for cytokeratin CAM 5.2; and 81 + for cytokeratin AE 1 : 3. The following significant correlations were identified. ADENSQ histology was associated with CEA-M staining (P < .025), and mucinous histology was associated with CA 19-9 staining (P < .025). Cervical primary site was associated with ADENSQ histology (P < .001) and staining with CEA-M (P < .025) and CEA-P (P < .05). Endometrial primary site was associated with endometrioid histology (P < .001). Forty-five patients had recurrent disease, 30 patients were disease-free for more than 1 year, and 12 patients had insufficient follow-up evaluation. Recurrent disease was associated with stage III or IV tumors (P < .001), grade 3 histology (P < .001), serous differentiation (P < .001), invasion to at least the middle third of the myometrium (P < .001) and large size of residual tumor at hysterectomy (mean 3.9 cm versus 1.3 cm, P < .005). Disease-free survival was associated with endometrioid differentiation (P < .05), strong CEA-M staining (P < .001), CEA-P staining (P < .025), and CA 19-9 staining (P < .05). Considering only stage 1 and 2 patients, grade 3 histology ( P < .025), deep myometrial invasion (P < .01), and size (P < .05) were still associated with recurrence and strong CEA-M staining (P < .025) was still associ ated with disease-free survival. However, strong CEA-M staining, deep myometrial invasion, and size of tumor after hysterectomy were all associated with histologic grade. Considering just histologic grade 3 carcinomas in stage 1 and 2 patients, absence of strong CEA-M staining, deep myometrial invasion, and size of tumor was no longer associated with recurrent disease. Histologic grade was the only independent predictor of prognosis in stage I and II patients. Int J Surg Pathol 1 (1): 13-24, 1993