title: Immunophenotypic alteration of the stromal component in minimal deviation adenocarcinoma ('adenoma malignum') and endocervical glandular hyperplasia: a study using oestrogen receptor and alpha-smooth muscle actin double immunostaining.
abstract: OBJECTIVE
  To define the phenotypic alteration of the stromal component in association with destructive invasion which is a crucial feature in distinguishing minimal deviation adenocarcinoma (MDA) from benign endocervical glandular lesions.
  
  
  RESULTS
  We studied endocervical glandular hyperplasias including non-specific-type (NEGH) (n = 3) and lobular-type (LEGH) (n = 8), and minimal deviation adenocarcinoma (MDA) (n = 11), well-differentiated endocervical adenocarcinoma of usual-type (WDA) (n = 11), and adenocarcinoma in situ (AIS) (n = 6) of the cervix, by double immunostaining for oestrogen receptor (ER) and alpha-smooth muscle actin (alpha-SMA) using peroxidase- and alkaline phosphatase-polymer methods, respectively. Glands in NEGH invariably showed nuclear staining for ER, with surrounding ER+/alpha-SMA- stromal cells, whereas LEGH also harboured ER+/alpha-SMA- spindle cells, but lacked nuclear staining for ER in constituent glands. In contrast, both WDA and MDA displayed accompanying stroma rich in alpha-SMA+ spindle cells in close vicinity to the infiltrating neoplastic glands, with only occasional weakly ER+ stromal cells. WDA tended to contain more alpha-SMA+ cells. The distribution of alpha-SMA+ cells was periglandular (6/11), patchy (6/11), and/or diffuse (4/11) in WDA, whereas in MDA it was periglandular (11/11) and/or patchy (8/11). AIS was surrounded by ER+/alpha-SMA- stromal cells. All cases of WDA, MDA, and AIS lacked nuclear staining for ER.
  
  
  CONCLUSIONS
  Both MDA and WDA can be distinguished from LEGH and NEGH by identifying surrounding alpha-SMA+ stromal cells and the absence or decreased number of ER+ cells, possibly as a result of the desmoplastic reaction with myofibroblasts replacing pre-existing ER+ stromal cells. In particular, the periglandular distribution of these alpha-SMA+ stromal cells can be a clue suggesting destructive stromal invasion in cases of MDA, although occasional glands may lack these cells.
authors.affiliation: Department of Pathology, Jikei University Medical School, Tokyo, Japan. mika@patholo2.med.tohoku.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Mikami
authors.forename: T
authors.initials: T
authors.lastname: Kiyokawa
authors.forename: T
authors.initials: T
authors.lastname: Moriya
authors.forename: H
authors.initials: H
authors.lastname: Sasano
mesh_terms: D000199:Actins / Q000032:analysis*; D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology*; D002584:Cervix Uteri / Q000737:chemistry / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry / Q000379:methods; D008679:Metaplasia; D009130:Muscle, Smooth / Q000737:chemistry; D009361:Neoplasm Invasiveness; D011960:Receptors, Estrogen / Q000032:analysis*; D002583:Uterine Cervical Neoplasms / Q000378:metabolism / Q000473:pathology*
chemical_list: D000199:Actins; D011960:Receptors, Estrogen