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Presented by Dr. Deyin Xing and prepared by Daniel Miller
43 years old woman with unilateral 14 cm ovarian mass. No cancer history. TAH-BSO.
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Question 1 of 1
1. Question
43 years old woman with unilateral 14 cm ovarian mass. No cancer history. TAH-BSO.
What is the correct diagnosis?
Correct
Answer: D. Metastatic endocervical adenocarcinoma
Histology: The tumor has a hybrid appearance with low-power endometrioid-like features but with apical mucin appreciable on higher power. The nuclei are hyperchromatic, elongated and diffusely atypical. Floating mitoses are readily recognized; apoptotic cells can also be appreciated at the basal portion of the glands. The areas with “Brenner tumor”-like distribution show highly atypical cells with features beyond that of benign Brenner tumor. These features plus strong and diffuse p16 as well as detected high risk HPV support interpretation as metastatic endocervical adenocarcinoma, usual type. Two submitted sections from cervix are unremarkable. Examination of entire clinically non-suspicious cervix is recommended.
Discussion: The nuclei are more atypical than seen in true endometrioid carcinomas with a similar degree of gland differentiation. Mucinous cystadenoma is composed of multiple
cysts and glands lined by simple, non-stratified mucinous epithelium resembling gastric foveolar-type or intestinal epithelium containing goblet cells. Mucinous cystadenomas may be associated with a dermoid cyst or Brenner tumor in around 10% of cases. The features in this case may raise concerns for mucinous cystadenoma with intraepithelial carcinoma. Strongly and diffusely expressed p16 and the presence of high risk HPV nail the diagnosis as metastatic endocervical adenocarcinoma, usual type.Incorrect
Answer: D. Metastatic endocervical adenocarcinoma
Histology: The tumor has a hybrid appearance with low-power endometrioid-like features but with apical mucin appreciable on higher power. The nuclei are hyperchromatic, elongated and diffusely atypical. Floating mitoses are readily recognized; apoptotic cells can also be appreciated at the basal portion of the glands. The areas with “Brenner tumor”-like distribution show highly atypical cells with features beyond that of benign Brenner tumor. These features plus strong and diffuse p16 as well as detected high risk HPV support interpretation as metastatic endocervical adenocarcinoma, usual type. Two submitted sections from cervix are unremarkable. Examination of entire clinically non-suspicious cervix is recommended.
Discussion: The nuclei are more atypical than seen in true endometrioid carcinomas with a similar degree of gland differentiation. Mucinous cystadenoma is composed of multiple
cysts and glands lined by simple, non-stratified mucinous epithelium resembling gastric foveolar-type or intestinal epithelium containing goblet cells. Mucinous cystadenomas may be associated with a dermoid cyst or Brenner tumor in around 10% of cases. The features in this case may raise concerns for mucinous cystadenoma with intraepithelial carcinoma. Strongly and diffusely expressed p16 and the presence of high risk HPV nail the diagnosis as metastatic endocervical adenocarcinoma, usual type.
