Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis.

PURPOSE: Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. METHODS: Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia-Ib1). RESULTS: A total of 271 patients were included in our literature review. 54 (20%) patients were treated by "conservative management" (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by "invasive management" (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. CONCLUSION: The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.

Tumor Handling of Early-stage Cervical Cancer: A Literature Analysis of Villoglandular Adenocarcinoma of the Cervix.

BACKGROUND/AIM: Recent studies have demonstrated the inferior overall survival outcomes of patients with early-stage cervical cancer who undergo minimally invasive surgery (MIS). One possible explanation for these unexpected results is intraoperative tumor manipulation. MATERIALS AND METHODS: Considering this hypothesis, we have reviewed the literature on the oncological outcomes of patients with villoglandular adenocarcinoma (VGA) of the cervix, an uncommon variant of cervical cancer that has an excellent prognosis. RESULTS: VGA generally presents as an exophytic mass arising from the endocervix. In a systematic review, we identified 221 patients treated surgically for VGA (FIGO stage Ia-Ib1). Of these, 11 developed recurrence, and four died. The recurrence sites in 8 cases were the pelvis (n=3), vaginal cuff (n=3), episiotomy scar (n=1), and cervix (n=1). Furthermore, 23 VGA-patients were treated by MIS, four experienced recurrence, and one died. Three intraabdominal metastases after MIS were reported. CONCLUSION: Excessive tumor-handling during MIS or manipulations, e.g. cervix-dilation (during delivery), can worsen the otherwise excellent prognosis.

Villoglandular adenocarcinoma of cervix: pathologic features, clinical management, and outcome.

BACKGROUND: The objective of the study was to investigate the management and prognosis of patients with villoglandular adenocarcinoma (VGA) of the uterine cervix. MATERIALS AND METHODS: The clinical presentation, pathology, management, and prognosis of 41 patients with VGA or other types of cervical adenocarcinoma (ADC) were retrospectively reviewed. RESULTS: During the patient follow-up period, the proportion of VGA was 8.1% in the cervical ADC cohort (41/507). The median age of the patients with VGA was 41.0 years. The most common presenting symptom was cervical contactive bleeding. There were 38 patients classified as FIGO stage IA1-IB. The median follow-up period was 38.5 months. There were no patient deaths, and only one patient showed recurrence. One of the patients delivered a healthy baby at 34 weeks of gestation prior to treatment with radical hysterectomy. The HPV HC2 test results showed that most patients were positive for HPV infection. HPV 16, 18, and 56 were positive in the 8 patients with HPV type test results. There were significant differences in the grade, depth of stromal invasion, lymph node metastasis, and recurrence between the VGA cases of FIGO stage I and the other types of cervical ADC of FIGO stage I (p<0.05). CONCLUSION: This study confirmed that VGA is a type of well-differentiated cervical cancer characterized by shallow stromal invasion, less lymph node metastasis. VGA is associated with less recurrence than other types of cervical ADC.

The clinicopathologic and immunohistochemical features of villoglandular adenocarcinoma of uterine cervix.

AIM: Villoglandular adenocarcinoma (VGA) of the uterine cervix is a variant of endocervical adenocarcinoma. However, the clinicopathologic and immunohistochemical features of VGA are still unclear. The aim of this study was to investigate the clinicopathologic and immunohistochemical features of VGA. MATERIALS AND METHODS: A total of 20 VGA patients were identified among 852 patients diagnosed with cervical cancer and enrolled in this study. The immunohistochemical levels of Ki-67, P53, P16, progesterone receptor (PR), carcinoembryonic antigen (CEA), vimentin (Vim), and estrogen receptor (ER) were measured by immunohistochemistry. RESULTS: VGA was prevalent in younger women and presented favorable prognosis. Ki-67, P16, and CEA were highly expressed in VGA tissues, while PR expression was hardly to be detected. The positive rates of Ki-67, CEA, and P16 were 90.0%, 90.0%, and 85.0%, respectively, which were significantly higher compared with PR (5.0%, P < 0.001). In addition, the positive rates of P53, Vim, and ER in VGA tissues were 55.0%, 50.0%, and 40.0%, respectively. However, the expression levels of Ki-67, P53, P16, PR, CEA, Vim, and ER were not significantly associated with clinical features (P > 0.05). CONCLUSION: These data indicate that VGA is a rare cervical adenocarcinoma, which is prevalent in younger women, and presents favorable prognosis. Detection of Ki-67, P53, P16, PR, CEA, Vim, and ER would be beneficial for the diagnosis of VGA.

Liquid-based cytology of villoglandular adenocarcinoma of the cervix: a report of 3 cases.

Villoglandular adenocarcinoma (VGA) is a rare subtype of cervical adenocarcinoma with a more favorable prognosis compared to conventional adenocarcinomas. Although the tumors are usually recognized on colposcopic examination due to the mainly exophytic growth pattern, they may be underdiagnosed as benign lesions by cytology because of their minimal cytologic atypia. We report the liquid-based cytology (LBC) findings of three histologically confirmed VGAs which we have recently identified. They were characterized by hypercellular smears on low-power examination with smooth-bordered three-dimensional papillary fragments. The nuclei were relatively uniform with irregular nuclear membranes. Nucleoli were small but distinct and macronucleoli were also seen. The abnormal architectural patterns such as papillary structures and nuclear overlapping and nuclear hyperchromasia are important clues to the diagnosis of VGA. In addition, nuclear membrane irregularity and prominent nucleoli can be recognized on LBC specimens, further facilitating its diagnosis.