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Difficulties in diagnosis of a minimal deviation adenocarcinoma of uterine cervix diagnosed postoperatively: brief communication and literature review

  • Gynecologic Oncology
  • Published:
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Abstract

Purpose

Rare minimal deviation adenocarcinoma (MDA) diagnosed postoperatively as incidental finding of a suspicious cervical lesion at laparoscopy, emphasizing it represents a diagnostic challenge mimicking both benign and malignant cervical lesions with often overlapping imaging characteristics—case report and literature review.

Case presentation

35-year-old Gravida with primary infertility presented with a suspicious cervical lesion and complained about menorrhagia, hyper-/dysmenorrhea. Clinical examination was unremarkable, transvaginal scan presented a 42 × 38 × 28 mm sized cervical lesion (i.e. fibroid) without hypervascularization. Unexpectedly, the diagnosis of minimal deviation adenocarcinoma in tissue sample taken from suspicious cervical lesion at laparoscopy was revealed in final pathological report. According to suspected early stage of MDA a radical abdominal hysterectomy (PIVER III/IV), bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymphadenectomy was scheduled. Final histology report confirmed: “MDA”, G2, FIGO pT1b1, pN0 (0/23 LN) L0 V0 Pn0 R0.

Results

Ultrasonography may indicate MDA throughout the examination of vascularization/echogenicity with possibility of mimicking benign lesions with similar characteristics. Magnetic resonance imaging shows no pathognomonic signs for MDA. Subsequently, a review of literature was conducted and main factors affecting the prognosis of MDA considering diagnostic tools, clinical stage, histopathological results and surgical protocols were analyzed.

Conclusions

Minimal deviation adenocarcinoma represents one of rare cervical adenocarcinomas without HPV-association. While it is crucial to differentiate benign from malignant lesions in this subtype, imaging characteristics often overlap and may not provide a specific diagnosis. Therefore, it should be considered in suspicious multicystic cervical lesions and inconclusive PAP-smear. Definitive diagnosis of this subtype should be based on cervical biopsy.

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Availability of data and material

Data were enrolled from medical records, intraoperatively from department of Gynecology and obstetrics and even from the institute of pathology, university Tübingen with informed consent.

Abbreviations

AM:

Adenoma malignum

MRI:

Magnetic resonance imaging

DWI:

Diffusion weighted imaging

GAS:

Gastric-type adenocarcinoma

MDA:

Minimal deviation adenocarcinoma

HPV:

Human papilloma virus

PAP:

Papanicolaou

WHO:

World Health Organisation

IHC:

Immunhistochemistry

CEA:

Carcinoembryonic

MIB-1:

Ki-67, Molecular Immunology Borstel

CK7:

Cyto keratine 7

CK20:

Cyto keratine 20

P16:

Cyclin dependent kinase inhibitor 2A

P53:

Transformation-related protein 53

CT:

Computed tomography

HIK1083:

Antibody

MUC6:

Antibody

CA19.9:

Carbohydrate-Antigen 19-9

PAX8:

Paired-Box-Protein 8

LEGH:

Lobular endocervical glandular hyperplasia

OS:

O7verall survival

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Authors and Affiliations

  1. Department für Frauengesundheit, Eberhard Karls Universitat Tubingen, Tübingen, Germany

    Alexandra Stoehr, Ernst Oberlechner, S. Y. Brucker & Cornelia Bachmann

  2. Institute of Pathology and Neuropathology, University of Tuebingen, Liebermeisterstraße 8, 72076, Tuebingen, Germany

    Dominik Nann & Annette Staebler

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  1. Alexandra Stoehr
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Contributions

AS conception, data acquisition, data analysis, preparation and writing of the manuscript. DN analysis of tumor specimen, selection of specimens for this case, data acquisition and data analysis. AStae analysis of tumor specimen, selection of specimens for this case, data acquisition and data analysis. EO review and proofreading of the manuscript. SB: review and proofreading of the manuscript. CB: conception, review and proofreading of the manuscript, coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Cornelia Bachmann.

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Stoehr, A., Nann, D., Staebler, A. et al. Difficulties in diagnosis of a minimal deviation adenocarcinoma of uterine cervix diagnosed postoperatively: brief communication and literature review. Arch Gynecol Obstet 300, 1029–1043 (2019). https://doi.org/10.1007/s00404-019-05286-7

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