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Presented by Alexander Truskinovsky, M.D. and prepared by Anil Parwani, M.D.,Ph.D
Case 3: 76 year old woman with atypical glandular cells of uncertain significance (AGUS) on Pap smear.
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Question 1 of 1
1. Question
Week 131: Case 3
76 year old woman with atypical glandular cells of uncertain significance (AGUS) on Pap smear.images/4703case3fig1.jpg
images/4703case3fig2.jpg
images/4703case3fig3.jpgCorrect
Answer: Metastatic adenocarcinoma
Histology: Sections show a well-circumscribed nodular lesion located beneath the surface epithelium. The tumor is cellular, with high grade cytologic atypia, brisk mitosis and numerous signet ring-like cells. Mucicarmine stain demonstrated focal intracellular mucin. The tumor cells showed strong, diffuse immunostaining for cytokeratin 20 and CEA. There was very focal positive staining for cytokeratin 7. Immunostains for p16, CD10 and gross cystic disease fluid protein were negative.
Discussion: This appears to be a poorly differentiated adenocarcinoma with signet ring cell features. The good circumscription of the lesion and lack of involvement of the surface epithelium argue against a primary cervical neoplasm. Strong, diffuse immunostaining for cytokeratin 20 and only focal expression of cytokeratin 7 is more typical for a carcinoma of colorectal or appendiceal origin.
Incorrect
Answer: Metastatic adenocarcinoma
Histology: Sections show a well-circumscribed nodular lesion located beneath the surface epithelium. The tumor is cellular, with high grade cytologic atypia, brisk mitosis and numerous signet ring-like cells. Mucicarmine stain demonstrated focal intracellular mucin. The tumor cells showed strong, diffuse immunostaining for cytokeratin 20 and CEA. There was very focal positive staining for cytokeratin 7. Immunostains for p16, CD10 and gross cystic disease fluid protein were negative.
Discussion: This appears to be a poorly differentiated adenocarcinoma with signet ring cell features. The good circumscription of the lesion and lack of involvement of the surface epithelium argue against a primary cervical neoplasm. Strong, diffuse immunostaining for cytokeratin 20 and only focal expression of cytokeratin 7 is more typical for a carcinoma of colorectal or appendiceal origin.
