8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.108 Microinvasive cancer. Large round and oval nuclei with
slightly irregularly distributed nuclear chromatin and irregular macronucleoli
(Papanicolaou x OI).
These figures demonstrate that in selected series, the cyto-
logic diagnosis of microinvasive carcinoma can be made with
high accuracy. A review situation, however, is essentially differ-
ent from a screening situation, in which the incidence of severe
abnormalities is usually very low. In those routine screening
situations, the primary diagnosis of "changes consistent with
microinvasive cancer" is made less frequently and with less
accuracy. The effort to diagnose epithelial abnormalities cyto-
logically as accurately as possible is encouraged. It is, however,
advisable to mention the possibility of a microinvasive cancer
rather than to give such a diagnosis with certainty. In general,
in routine cytodiagnosis, making a firm diagnosis of a microin-
vasive carcinoma should be avoided. In addition to a diagnosis
of an invasive cancer, the possibility that the process might be
microinvasive may be mentioned. Such a diagnosis is based on
very delicate differences between the characteristics of carcino-
mas in situ and invasive cancers. A suggestion of too high a pre-
cision would be misunderstood against the background of the
relatively high rate of false diagnoses, which unfortunately are
still being made and may potentially reduce clinical acceptance
of diagnostic cytopathology.
Table 8.2 Distribution of histologic types in primary invasive cancers of
the cervix
Type
Distribution
Squamous cell cancer
Nonkeratinizing
3.3%
Keratinizing
29.1%
Small cell cancer
10.9%
Adenosquamous carcinoma
7.0%
Adenocarcinoma
6.2%
Clear cell carcinoma
1.5%
Adenocanthoma
0.8%
Adenoid cystic carcinoma
0.2%
Data from Ng and Reagan.212
invasive cervical cancer
According to the International Committee on Histological Ter-
minology for Lesions of the Uterine Cervix, "any lesion in which
epithelial formations invade the underlying stroma by infiltra-
tion or destruction is to be classified as invasive carcinoma."80
In a large series of primary invasive cancers of the cervix, Ng
and Reagan found the distribution of histologic types shown
in Table 8.2.212 Keratinizing and nonkeratinizing squamous cell
cancer may originate from the original nonkeratinizing strati-
fied ectocervical squamous epithelium and from metaplastic
epithelium in the endocervical canal.
Small-cell carcinoma originates in undifferentiated precur-
sor cells of the endocervical columnar epithelium, which lack
every differentiation into columnar or squamous epithelium.
The group of small-cell cancers is probably not a homogeneous
group. Jones and associates, based on the ultrastructural dem-
onstration of neurosecretory granules in the cytoplasm of these
cells, suggested that part of these tumors were of neuroendocrine
origin and probably originated from amine precursor uptake and
decarboxylation cells in the cervix.213 This finding is supported by
the demonstration of argentaffin (Kultchitsky) cells in small-cell
cancers of the cervix, which suggests a relationship with small-
cell cancers of the bronchus (extrapulmonary small-cell can-
cer).214 Adenocarcinomas with the subtype of clear cell carcinoma
originate from the endocervical columnar epithelium, derived
from the embryologic mullerian epithelium. Adenocarcinomas
are also found to originate from mesonephric duct remnants,
known as mesonephric carcinomas. Adenocarcinomas with an
admixture of a benign or a malignant squamous component—
adenoacanthoma and adenosquamous carcinoma—most likely
originate from undifferentiated precursor cells of the endocervical
columnar epithelium, with a dual development into columnar
epithelium and squamous epithelium. For a detailed description
of adenocarcinomas and precursor lesions, see Chapter 9, Glan-
dular Neoplasms of the Uterine Cervix.
Age at Detection
Patten, in a series of 61 cases, found a mean age at detection of
53.4 years.9 Reagan and Hicks found a mean age of 48.2 years.146
In our own series of 435 cases of squamous cell cancer of the
cervix, the mean age was 53.0 years (standard deviation of 13.9
years) (see Fig. 8.80).
189
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