A clinicopathological and immunohistochemical study of minimal deviation adenocarcinoma of the uterine cervix.

Objective: To investigate the clinical, pathological and immunohistochemical features of minimal deviation adenocarcinoma (MDA) of the uterine cervix by conducting a retrospective study of 25 cases consecutively treated in three institutes over a 10 years period.

Methods: Of 25 cases with MDA, clinical features were retrospectively reviewed, gross and micro appearances of surgical specimens of 17 operative cases were observed. Ki67, SMA, p53, PCNA, Vimentin, CEA, ER, CA125 and PR were detected on tissues from MDA and 50 cases common adenocarcinomas of the uterine cervix (AUCs) (differentiation rank: high 16, moderate 20, low 14). Their expressions were assessed in paraffin sections using the immunohistochemistry method.

Results: MDA accounted for only 1.2% of adenocarcinomas of the uterine cervix. The main clinical manifestations were vaginal profuse, watery or mucoid discharge and irregular bleeding. Signs were cervical hypertrophy or thickening. The gross appearance showed many similarities with common AUCs. Immunohistochemical results: the positive rates for p53 and Ki67 in >50% of the cell nuclei (Ki67/50(+)) were 88% and 64% in MDA respectively, significantly higher than common AUCs (38%, 18%, P<0.01), CA 125 was 18% in MDA, clearly lower than common AUCs (58%, P<0.01). There was no difference between MDA and common AUCs for CEA, PR, Vimentin, ER, PCNA and SMA (P>0.05). No significant difference was noticed among the high, moderate and low differentiation groups in common AUCs (P>0.05).

Conclusions: For early stage diagnoses, MDA should be considered when cervical hypertrophy is present in patients complaining of a vaginal profuse watery or mucoid discharge and irregular bleeding. Positive immunohistochemical staining for p53, Ki67/50(+) and negative for CA125 can assist diagnosis and discrimination.