Definition/General
Introduction:
Cervical solid carcinoma is a variant of endocervical adenocarcinoma characterized by predominantly solid growth pattern with minimal glandular differentiation
It typically shows intermediate to high-grade nuclear features and aggressive behavior.
Origin:
Arises from endocervical glandular epithelium with loss of typical glandular architecture
Shows solid sheets and nests of malignant cells
Associated with high-risk HPV infection.
Classification:
WHO Classification recognizes solid adenocarcinoma as variant of cervical adenocarcinoma
Characterized by >75% solid growth pattern.
Epidemiology:
Uncommon variant, 3-8% of cervical adenocarcinomas
Peak incidence 35-55 years
Strong HPV association (especially HPV 18)
Generally poor prognosis.
Clinical Features
Presentation:
Abnormal vaginal bleeding
Large cervical mass
Advanced stage at presentation common
Rapid clinical progression
Pelvic pain.
Symptoms:
Abnormal vaginal bleeding (heavy, irregular)
Pelvic pain or pressure
Vaginal discharge
Constitutional symptoms (weight loss, fatigue)
Urinary or bowel symptoms.
Risk Factors:
High-risk HPV infection (especially HPV 18)
Age 35-55 years
Oral contraceptive use
Smoking
Multiple sexual partners
Immunosuppression.
Screening:
Pap smear may show atypical glandular cells
HPV testing important
Advanced imaging often shows large mass
Tissue diagnosis required.
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Gross Description
Appearance:
Large, firm, infiltrative mass with irregular borders
Cut surface shows solid, homogeneous appearance
Areas of hemorrhage and necrosis common.
Characteristics:
Size typically large (>3 cm)
Firm consistency
Gray-white to tan coloration
Solid, fleshy texture
Extensive necrosis possible.
Size Location:
Often involves entire cervix at presentation
Deep cervical wall invasion typical
Early parametrial and vaginal extension.
Multifocality:
Usually unifocal but extensive
May be associated with endocervical adenocarcinoma in situ
Infiltrative growth predominant.
Microscopic Description
Histological Features:
Solid sheets and nests of malignant epithelial cells with minimal glandular differentiation
Intermediate to high-grade nuclear features
Extensive infiltrative growth pattern.
Cellular Characteristics:
Cuboidal to polygonal cells with moderate to abundant eosinophilic cytoplasm
Intermediate to high-grade nuclei
Prominent nucleoli
High mitotic rate.
Architectural Patterns:
Predominantly solid growth (>75%)
Sheets and nests of cells
Minimal glandular lumen formation
Infiltrative borders
Desmoplastic stroma.
Grading Criteria:
Intermediate to high-grade adenocarcinoma
Nuclear grade moderate to high
Architecture predominantly solid
High mitotic rate typical.
Immunohistochemistry
Positive Markers:
p16 diffuse positive (HPV-associated)
CK7 positive
PAX8 positive
CEA positive
EMA positive.
Negative Markers:
CK20 negative
CDX2 negative
TTF-1 negative
p63 negative
Vimentin typically negative.
Diagnostic Utility:
p16 confirms HPV association
CK7 and PAX8 support Müllerian origin
CEA confirms epithelial differentiation
Helps distinguish from other solid tumors.
Molecular Subtypes:
HPV-associated solid adenocarcinoma
Poorly differentiated variant with solid architecture.
Molecular/Genetic
Genetic Mutations:
HPV integration (especially HPV 18)
PIK3CA mutations common
KRAS mutations
TP53 mutations possible
PTEN alterations.
Molecular Markers:
High-risk HPV DNA detection
p16 overexpression
High Ki-67 index (>30%)
p53 alterations in some cases.
Prognostic Significance:
Generally poor prognosis due to solid architecture and high grade
Early metastasis common
Stage and nodal status important.
Therapeutic Targets:
Standard cervical cancer treatment protocols
Chemotherapy often required
Targeted therapies under investigation.
Differential Diagnosis
Similar Entities:
Poorly differentiated squamous carcinoma
Undifferentiated carcinoma
Neuroendocrine carcinoma
Metastatic adenocarcinoma.
Distinguishing Features:
Solid adenocarcinoma: CK7+, PAX8+, p16+
Squamous: p63+, CK5/6+
Neuroendocrine: synaptophysin+, chromogranin+.
Diagnostic Challenges:
Distinction from other solid tumors
Recognition of epithelial differentiation
Assessment of primary vs
metastatic disease.
Rare Variants:
Mixed solid and conventional adenocarcinoma
Solid with neuroendocrine differentiation
Pleomorphic variant.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]