Case 8

A 40-year-old female with a cervical mass presented with abnormal uterine bleeding. An endometrial biopsy as well as endocervical curettage were sent for pathology. Below is the EMB sample:

1.What is the diagnosis by morphology?

A: FIGO3 endometrioid carcinoma

B: Clear cell carcinoma

C: Endometrioid carcinoma with mucinous differentiation

D: Invasive stratified mucin producing carcinoma

E: Squamous cell carcinoma

F: Microgandular hyperplasia

Answer

The tumor appears to be squamoid with focally glandular lumen with mucin in both intracytoplasm and gland lumen. Knowing that there is a cervical mass help us to think primary endometrioid versus endocervical tumors in this case. Stay tuned for the endocervical sections in question 2 for final answer.

2. Here is the section from the ECC specimen:

A panel of immunostains showed that the tumor cells are diffusely positive for P16, negative for ER. What's the final diagnosis?

A: FIGO3 endometrioid carcinoma

B: Clear cell carcinoma

C: Endometrioid carcinoma with mucinous differentiation

D: Invasive stratified mucin producing carcinoma

E: Squamous cell carcinoma

F: Microgandular hyperplasia

Answer

The correct answer is D. It is the invasive counterpart of stratified mucin producing intraepithelial lesion (SMILE) and is associated with high risk HPV infection. Several helpful morhological features are identified: 1) solid infiltrative nests of stratified mucinous cells 2) Peripheral palisading 3) intratumoral and peritumoral neutrophils. As conventional HPV- associated endocervical adenocarcinoma, I-SMILE is diffusely positive for p16 and negative for ER PR.

References: https://www.pathologyoutlines.com/topic/cervixinvasivestratifiedmucincarc.html

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD