Six cases of a rare variant of endocervical adenocarcinoma (Adenoma maligum, AM) were collected for clinicopathologic analysis, The average age of six patients was 49.3 years, and their chief complaints were persistent mucoid or watery discharge
and
intermittent vaginal potting. The clinical impression was carcinoma of the uterine cervix in four out of six cases. All except one were pathologically confirmed by initial biopsy: two cases by colposcopic biopsies, two by cone biopsies, one by
cone
biopsy after suggested AM in colposcopic biopsy. One case was incidentally found from hysterectomised specimen, which was suspected as adenomyosis.
On gross examination, the cervix usually appeared either firm or indurated with thickening of the wall except one which was presented as a fungating mass. The characteristic histologic features were extensive arborizing endocervical glands with
marked
variation in size and the glands lined by mucin containing columnar epithelial cells with basal bland-looking nuclei but with occasional cytologic atypia and rare mitoses. The neoplastic glands were characterized by deep stromal invasion beyond
normal
endocervical glands, associated with loose edematous periglandular desmoplastic stromal reaction in most cases. Immunohistochemical stainings for carcinoembryonic antigen (CEA) revealed cy toplasmic positivity in five cases. The clinical stage
for
all
except one incidental case were: four Ib and one Ⅱb.
In three cases, the radical hysterectomy with unilateral salpingooophorectomy plus dissection of bilateral pelvic and paraaortic lymph nodes was performed, and in one case radiotherapy was done prior to radical hysterectomy with bilateral
salpingoophorectomy plus the dissection of left pelvic lymph nodes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation followed by radiation therapy was performed in on case. The
remaining
one case was treated with radiation therapy. Metastasis to the left obturator lymph node was discovered in one case with state IIb, and the patient expired 29 months after the radiotherapy. The remaining five cases are being carefully followed
up.
From our experience, we conclude that the early diagnosis of AM can be made based on comprehensive analysis concerning the clinical features, histopathological and immunohistochemical findings. The early diagnosis and proper therapy can lead to
the
better prognosis.
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