title: Gastric-type Endocervical Adenocarcinoma: An Aggressive Tumor With Unusual Metastatic Patterns and Poor Prognosis.
abstract: Gastric-type adenocarcinoma of the uterine cervix (GAS) is a rare variant of mucinous endocervical adenocarcinoma not etiologically associated with human papillomavirus (HPV) infection, with minimal deviation adenocarcinoma (MDA) at the well-differentiated end of the morphologic spectrum. These tumors are reported to have worse prognosis than usual HPV associated endocervical adenocarcinoma (UEA). A retrospective review of GAS was performed from the pathology databases of 3 institutions spanning 20 years. Stage, metastatic patterns, and overall survival were documented. Forty GAS cases were identified, with clinical follow-up data available for 38. The tumors were subclassified as MDA (n=13) and non-MDA GAS (n=27). Two patients were syndromic (1 Li-Fraumeni, 1 Peutz-Jeghers). At presentation, 59% were advanced stage (FIGO II to IV), 50% had lymph node metastases, 35% had ovarian involvement, 20% had abdominal disease, 39% had at least 1 site of metastasis at the time of initial surgery, and 12% of patients experienced distant recurrence. The metastatic sites included lymph nodes, adnexa, omentum, bowel, peritoneum, diaphragm, abdominal wall, bladder, vagina, appendix, and brain. Follow-up ranged from 1.4 to 136.0 months (mean, 33.9 mo); 20/38 (52.6%) had no evidence of disease, 3/38 (7.9%) were alive with disease, and 15/38 (39.5%) died of disease. Disease-specific survival at 5 years was 42% for GAS versus 91% for UEA. There were no survival differences between MDA and non-MDA GAS. GAS represents a distinct, biologically aggressive type of endocervical adenocarcinoma. The majority of patients present at advanced stage and pelvic, abdominal, and distant metastases are not uncommon.
authors.affiliation: *Pathology Department, North Western State Medical University, St Petersburg, Russia †Department of Pathology, Jikei University School of Medicine, Tokyo, Japan ‡Department of Pathology, Yale School of Medicine, New Haven, CT Departments of §Epidemiology and Biostatistics ∥Pathology, Memorial Sloan Kettering Cancer Center ¶Weill Cornell Medical College, New York, NY.
authors.forename: Yevgeniy S
authors.initials: YS
authors.lastname: Karamurzin
authors.forename: Takako
authors.initials: T
authors.lastname: Kiyokawa
authors.forename: Vinita
authors.initials: V
authors.lastname: Parkash
authors.forename: Anjali R
authors.initials: AR
authors.lastname: Jotwani
authors.forename: Prusha
authors.initials: P
authors.lastname: Patel
authors.forename: Malcolm C
authors.initials: MC
authors.lastname: Pike
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Kay J
authors.initials: KJ
authors.lastname: Park
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000145:classification / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D002454:Cell Differentiation; D003237:Connecticut; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy