Definition/General
Introduction:
Cervical villoglandular carcinoma is a rare, well-differentiated variant of endocervical adenocarcinoma characterized by papillary architecture with thin fibrovascular cores and superficial stromal invasion
It generally has better prognosis than conventional adenocarcinoma.
Origin:
Arises from endocervical glandular epithelium with distinctive papillary growth pattern
Shows superficial stromal invasion typically <3mm
Associated with high-risk HPV infection.
Classification:
WHO Classification recognizes villoglandular adenocarcinoma as variant of cervical adenocarcinoma
Well-differentiated subtype with papillary architecture.
Epidemiology:
Peak incidence 25-45 years (younger than conventional adenocarcinoma)
Represents <1% of cervical cancers
Strong HPV association (especially HPV 18)
Generally excellent prognosis.
Clinical Features
Presentation:
Abnormal vaginal bleeding
Watery vaginal discharge
Abnormal Pap smear
May present as exophytic cervical lesion.
Symptoms:
Abnormal vaginal bleeding (intermenstrual, postcoital)
Profuse watery discharge
Pelvic discomfort
May be asymptomatic initially.
Risk Factors:
High-risk HPV infection (especially HPV 18)
Young age
Oral contraceptive use
Multiple sexual partners
Early sexual activity.
Screening:
Pap smear may show glandular abnormalities
HPV testing important
Colposcopy may show exophytic lesion
Endocervical curettage diagnostic.
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Gross Description
Appearance:
Exophytic, papillary, or polypoid lesion
Soft, friable consistency
May have villous surface architecture
Variable size.
Characteristics:
Size typically 1-4 cm
Soft, friable consistency
Papillary or villous surface
Pink to gray-white coloration
May bleed easily.
Size Location:
Arises from endocervical canal
May protrude through external os
Superficial growth pattern typical
Minimal deep invasion.
Multifocality:
Usually unifocal
May be associated with endocervical adenocarcinoma in situ
Surface growth predominant.
Microscopic Description
Histological Features:
Papillary architecture with thin fibrovascular cores lined by columnar epithelium
Superficial stromal invasion typically <3mm
Well-differentiated morphology.
Cellular Characteristics:
Tall columnar cells with mild nuclear atypia
Stratified nuclei
Mucin-containing cytoplasm
Low nuclear grade
Minimal pleomorphism.
Architectural Patterns:
Complex papillary architecture
Thin fibrovascular cores
Back-to-back glands
Cribriform pattern possible
Surface involvement prominent.
Grading Criteria:
Well-differentiated (Grade 1)
Low nuclear grade
Low mitotic rate
Organized architecture
Superficial invasion pattern.
Immunohistochemistry
Positive Markers:
p16 diffuse positive (HPV-associated)
CEA positive
CK7 positive
PAX8 positive
Mucin stains positive.
Negative Markers:
CK20 negative
p63 negative
TTF-1 negative
CDX2 negative
CK5/6 negative.
Diagnostic Utility:
p16 confirms HPV association
CEA and mucin stains support glandular differentiation
PAX8 confirms Müllerian origin.
Molecular Subtypes:
HPV-associated villoglandular adenocarcinoma
Well-differentiated endocervical type.
Molecular/Genetic
Genetic Mutations:
HPV integration (especially HPV 18)
PIK3CA mutations possible
KRAS mutations
TP53 mutations rare
Lower mutation burden.
Molecular Markers:
High-risk HPV DNA detection
p16 overexpression
Low Ki-67 index
Well-differentiated gene expression profile.
Prognostic Significance:
Excellent prognosis with superficial invasion
Low recurrence rate
Stage IA1 behavior typical
Conservative treatment possible.
Therapeutic Targets:
HPV-targeted therapy
Conservative surgical management
Fertility-sparing approaches
Adjuvant therapy rarely needed.
Differential Diagnosis
Similar Entities:
Endocervical adenocarcinoma in situ
Conventional endocervical adenocarcinoma
Endometrial adenocarcinoma
Tubal metaplasia.
Distinguishing Features:
Villoglandular: Papillary, superficial invasion
AIS: No invasion
Conventional adenocarcinoma: Deeper invasion, higher grade.
Diagnostic Challenges:
Assessment of invasion depth
Distinction from AIS
Recognition of papillary architecture
Measurement of stromal invasion.
Rare Variants:
Mixed villoglandular and conventional adenocarcinoma
Villoglandular with squamous differentiation.
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]