Cervical cancer

Diagnosis of cervical and
endocervical cancers
By
W.L.N.V Vara prasad….

Cervical cancer
 Cancer of the uterine cervix is one of the leading
cancer among women worldwide with an estimated
520,000 new cases and 274,000 deaths reported
annually (WHO/ICO Information Centre on HPV and
Cervical Cancer- HPV and cervical cancer statistics in
India. 2010).
 About 86% of the cervical cancer cases occur in
developing countries, which represents 13% of all
female cancers (WHO/ICO Information Centre on
HPV and Cervical Cancer- HPV and cervical cancer
statistics in India. 2010).

Risk factors or Etiology
 Human papilloma virus
 Smoking
 How many children you have, and when
 The contraceptive pill
 A drug called diethylstilboestrol
 Exposure to a chemical called tetrachloroethylene
 A weakened immune system
 Genetics - ethnic groups and family links
 Social Class

Molecular note
Tumors of uterine cervix – international agency for reaserch on cancer

Brief note histology
 Gross anatomy
 The cervix is actually the lower, narrow portion of
the uterus.
 Its name is derived from the Latin word for "neck."
 It is cylindrical or conical in shape.
Cervical Histology and Infectious Diseases
Kristyn Feldman

Normal Histology
 The cervix is covered by both columnar and stratified
non-keratinising squamous epithelia.
 The squamocolumnar junction (SCJ), where these
two meet, is the most important cytologic and
colposcopic landmark, as this is where over 90% of
lower genital tract neoplasia arises.

Glandular or Columnar Epithelium
 Covers a variable amount of the ectocervix and lines the
endocervical canal.
 It is comprised of a single layer of mucin secreting cells.
 Longitudinal folds and invaginations make up the so-called
endocervical glands (they are not true glands).

Koilocytotic atypia = HPV infection
 Perinuclear vacuolation
 Dense and irregular-staining
peripheral cytoplasm
 Enlarged nucleus
 Undulating nuclear membrane
(raisin-like)
 Rope-like chromatin pattern
 Binucleation/multinucleation may
occur

Classification of cervical cancer
Squamous cell
tumors
Glandular tumors
Stromal or
mesenchymal tumor Mixed

Classification of cervical cancer

CERVICAL SQUAMOUS
NEOPLASIA
 An invasive carcinoma composed of squamous cells
of varying degrees of differentiation.
 Macroscopically : - Exophytic growth, Endophytic.
 Histopathology:
 Keratinizing, Non-keratinizing
 Basaloid, Verrucous, Warty, Papillary
 Cervical intra epithelial neoplsia (CIN 1,2,3)
Tumors of uterine cervix – international agency for reaserch on
cancer

Nuclear abnormalities
 Nuclei are enlarged, of variable size, and show
irregularity in their shape and contour.
Hyperchromasia and irregular chromatin clumping
are present, and the nuclear membrane may be
wrinkled.
 The nuclear : cytoplasmic ratio is increased and
the polarity of the nuclei may be altered, giving a
disorganised arrangement.
 The term ‘nuclear atypia’ encompasses this range
of nuclear changes.
Histopathology Reporting in Cervical Screening – an Integrated Approach - NHS Cervical
Screening Programme

Alterations in epithelial
maturation
 The term ‘maturation’ tends to be used
synonymously with epithelial differentiation in the
cervix. As squamous epithelial cells mature, the
nuclear : cytoplasmic ratio decreases towards
the epithelial surface, so that the cytoplasmic
component predominates in superficial cells.
 The proportion of the epithelium that shows
maturation is one of the features used to grade
CIN.
Screening Programme

CIN I
Nuclear atypia but prominent in basal one third
Cytoplasmic maturation confined to upper two thirds.
Mitotic figures
CIN II
Nuclear atypia entire squamous cell layer
Cytoplasmic maturation confined to upper one thirds.
Mitotic figures entire squamous cell layer
CIN III
Nuclear atypia entire squamous cell layer.
Cytoplasmic maturation absent if present only seen in superficial
layer.
Mitotic figures entire squamous cell layer.
Nuclear atypia and mitotic figures are prominent

SQUAMOUS NEOPLASIA -
classification
 Cervical intraepithelial neoplasia (CIN) classification.

CIN 1 CIN
2
CIN 3
Screening Programme

P16 - cyclin-dependent kinase-4 inhibitor
 p16 - limited expression in normal tissues and tumors.
 Diffuse (as opposed to focal) positivity with p16 in the
cervix can be regarded as a surrogate marker of the
presence of high-risk human papillomavirus (HPV).
 positive in most high-grade cervical intraepithelial
neoplasia.
p16 expression in the female genital tract and its value
in diagnosis. O'Neill CJ, McCluggage WG

Ki-67/MIB-1 in Cervical Cancer
 Ki-67, a protein in the nuclei of growing cells and
expresses – in the G1, S, G2 and M phases of the cell
cycle, is associated with cellular proliferation.
 Ki-67 antigen can react with its monoclonal
antibodyMIB-1.
 Ki-67/MIB-1 expression shows a correlation with poor
prognosis.
The Prognostic Role of Ki-67/MIB-1 in Cervical Cancer: A Systematic Review
with Meta-Analysis
Denghua Pan, Kanglai Wei, Yanxin Ling, Shitao Su, Meilin Zhu, and Gang Chen

Basaloid – Squamous cell carcinoma
 Defination:- Basaloid squamous cell carcinoma is
composed of nests of immature, basal type
squamous cells with scanty cytoplasm that
resemble closely the cells of squamous carcinoma
in situ of the cervix.
 Some keratinization may be evident in the centres
of the nests, but keratin pearls are rarely present.
cancer
Immunoprofile:
• CK5/6 or p63 can be used in some cases to confirm the diagnosis.
• Neuroendocrine markers (synaptophysin, chromogranin, and CD56) can exclude
neuroendocrine carcinoma.

 Grossly the tumor shows ulcerative infiltrating
growth pattern.
 Microscopically characterized by infiltrating growth
pattern is in the form of nests, lobules, trabeculae and
groups of small basaloid cells.
 These cells are ovoid and relatively uniform in size,
with scant cytoplasm and a high nuclear cytoplasmic
ratio, thus the tumor cells appear undifferentiated.
Nucleus contains evenly distributed coarsely granular
chromatin.
Basaloid squamous cell carcinoma of uterine cervix- A case report
A Sharadrutha 1, G Anandam 2

Basaloid – Squamous cell carcinoma
The tumour is composed of small,
basaloid cells with scanty cytoplasm.
Foci of squamous differentiation and
keratinisation can be seen in the centre
of the basaloid islands
Rapid developing basaloid squamous cell carcinoma of the uterine cervix in a young adult
Taiwanese Horng- Jyh TSAI MD, PhD, Bin LIOU, MD and Mu-Chun LI MD

Verrucous carcinoma
 Highly differentiated
squamous cell carcinoma that
has a hyperkeratotic,
undulating, warty surface
and invades the underlying
stroma in the form of
bulbous pegs with a pushing
border. The tumour cells have
abundant cytoplasm, and their
nuclei show minimal atypia.
Verrucous Carcinoma of the Cervix: Detection of Carcinogenetic
Human Papillomavirus Types and their Role during Follow-up
ANTONIO FREGA1, ANKICA LUKIC1, FLAVIA NOBILI1, ANTONELLA PALAZZO1,
ROBERTO IACOVELLI1, DEBORAH FRENCH2 and MASSIMO MOSCARINI1

Clinically it has proliferative finger like
projections or a cauliflower like appearance
which is a significant factor in its diagnosis

A rare case of verrucous carcinoma of the cervix in a patient with uterine
Prolapse M R M Rishard1, A K P Ranaweera1, H R Seneviratne2, A Kaluarachchi2, D
Abeygunawardane3
Third degree uterovaginal prolapse with
exophytic growth in the upper lip of the
cervix.
Histological appearance showing sheets
and nests of polygonal cells invading
underlying stroma. Cells contain
abundant cytoplasm and nuclei with
minimal atypia and keratin pearls

condyloma acumina
Papillary - SQCC
1. Papillary squamous cell carcinoma
(SCC) of the uterine cervix has been
defined as a malignant squamous cell
lesion characterized by a papillary
architecture with fibrovascular cores
and moderate to severe dysplasia
devoid of frank keratinization and
koilocytic change.
2. Papillary SCC should be
histopathologically delineated from
other rare variants of SCC with
papillary features including verrucous
and warty squamous cell carcinoma.

Lymphoepithelioma-like carcinoma
 Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a
rare variant of squamous cell carcinoma of the uterine cervix. This
tumor is characterized by nests of poorly differentiated epithelial cells
surrounded by a prominent lymphocytic infiltration.
 The tumour is composed of cells of uniform appearance with large
vesicular nuclei, prominent nucleoli, and moderate amounts of
indistinct eosinophilic cytoplasm.
 Most of the infiltrating lymphocytes mark as T cells.
 Lymphoepithelioma-like carcinomas are associated with a favourable
prognosis and a low incidence of node metastases.
 Histopathologically, it closely resembles classic nasopharyngeal
carcinoma.
A case of lymphoepitheliomalike carcinoma in the uterine cervix
Kanetoshi Takebayashi, Masakazu Nishida, Harunobu Matsumoto, Kaei Nasu, Hisashi
Narahara

The pathological
results revealed
some
tumor parts with
intense
infiltration of
lymphocytes
and lesions that
looked like
lymphoma
Carcinomatous and necrotic
tissue is visible at the uterine
cervix. An adequate margin of
the vaginal wall and cardinal
ligament were removed by the
radical hysterectomy.

Adenocarcinoma of the Cervix
 A carcinoma that shows glandular differentiation.
 About one-half of all adenocarcinomas are exophytic,
polypoid or papillary masses.
 Others are nodular with diffuse enlargement or
ulceration of the cervix.
 Deep infiltration of the wall produces a barrel-shaped
cervix.
 Approximately 15% of patients have no visible lesion.

Classification of Adenocarcinoma
 Mucinous
adenocarcinoma:
1. Intestinal variant
2. Endocervical variant
3. Signet-ring cell variant
4. Minimal deviation
variant
5. Villoglandular variant
6. Gastric variant
• Endometrioid adenocarcinoma
• Clear cell adenocarcinoma
• Serous adenocarcinoma
• Mesonephric adenocarcinoma

Mucinous Endocervical adenocarcinoma
 An adenocarcinoma in which at least some of the cells
contain a moderate to large amount of intracytoplasmic
mucin.
 Endocervical variant
 Intestinal variant
 Signet-ring cell variant
 Minimal deviation variant
 Villoglandular variant
 Gastric variant
cancer

Immunoprofile:
• Diffuse expression of CK7, CEA, and p16 occurs.
• ER, PR, and vimentin are usually negative.
• A panel of CEA, p16, ER, vimentin, and HPV
markers may help to exclude primary endometrial
adenocarcinoma of endometrioid type in
problematic cases

Endocervical adenocarcinoma
 Adenocarcinoma in situ (AIS) is the precursor lesion to
invasive endocervical adenocarcinoma.
 On histology, AIS is characterised by the presence of
atypical glandular cells replacing the normal glandular
mucosa of the endocervix while preserving its normal
lobular architecture.
 The demarcation between the benign and neoplastic
glandular cells is usually abrupt. The diagnostic features
include nuclear stratification, loss of the normal nuclear
polarity, increased nuclear size, hyperchromasia, altered
chromatin pattern, mitotic activity and apoptosis.

Mucinous adenocarcinoma, intestinal type
These tumours resemble adenocarcinoma of the large
intestine. Intestinal-type change may be found diffusely
or only focally within a mucinous tumour. They
frequently contain goblet cells and less commonly
endocrine and Paneth cells. Identification of goblet cells
in variable amount is the key feature to establish the
diagnosis
Primary signet-ring cell adenocarcinoma
It is rare in pure form. Signet-ring cells
occur more commonly as a focal finding
in poorly differentiated mucinous
adenocarcinomas and adenosquamous
carcinomas. The differential diagnosis
includes metastatic tumours or rare
squamous cell carcinomas with signet-
ring-like cells that are mucin negative.

Mucinous adenocarcinoma: signet
ring cell type. The presence of
intracytoplasmic mucin vacuoles
characterises these tumours along with
signet ring cells
Mucinous adenocarcinoma,
intestinal type: this uncommon
variant of primary cervical
adenocarcinoma resembles colonic
adenocarcinoma and contains
goblet cells.

Signet ring cell
adenocarcinoma
of intestines

Minimal deviation adenocarcinoma (MDA), also termed 'adenoma
malignum
• The tumor was termed as adenoma malignum because of the
resemblance of its glands to endocervical glands and its lack of
malignant cellular features.
•MDA is a rare form of cervical adenocarcinoma characterized by
glandular proliferation with little or no stratification and is comprised of
well-differentiated columnar epithelium of an endocervical type.
•Because of the high degree of differentiation, there is a high frequency
of failure to diagnose this malignancy histologically.
•Minimal deviation adenocarcinoma is uncommon and accounts for only
1-3% of all cervical adenocarcinomas and most pathologists diagnose
only one or two cases during their professional life.

Mucinous adenocarcinoma:
minimal deviation variant.
Neoplastic glands are irregularly
spaced and have abnormal
contours. In typical cases, there is
minimal cytological atypia.
Mucinous adenocarcinoma:
villoglandular variant. This exophytic
tumour exhibits a fronded growth of
papillae, which are covered by mildly
dysplastic endocervical-type
epithelium. There is no stromal
invasion in this example.

Mucinous adenocarcinoma: villoglandular variant

Mucinous adenocarcinoma: gastric type. The
tumour cells have abundant clear cytoplasm with
sharp cell borders.

Immunoprofile:
• Intestinal-type mucinous adenocarcinoma labels
diffusely for CK7, focally or diffusely for CK20
and CDX2, and variably for p16.
• Signet ring cancer usually express CK7, CEA, and
p16.
• Minimal deviation adenocarcinoma display a
pyloric gland immunophenotype (HIK1083 and
MUC6 positive).

Endometrioid adenocarcinoma
 The tumours comprise simple or complex glands that
are lined by endometrioid-type epithelium with
stratified nuclei and minimal intracytoplasmic mucin.
 Its diagnosis carries some subjectivity and the
distinction between a true endocervical endometrioid
adenocarcinoma and an endocervical adenocarcinoma
with minimal amount of mucin is difficult.
 • Spread from a primary tumour in the uterine corpus
should be excluded and immunohistochemistry may
assist in this regard. (A panel of CEA, p16, ER, vimentin, and
HPV markers may help to exclude primary endometrial
adenocarcinoma of endometrioid type in problematic cases)

Clear cell adenocarcinoma
 An adenocarcinoma that is composed mainly of
clear or hobnail cells arranged in solid, tubulocystic
or papillary patterns or a combination.
 This rare tumour is histologically similar to clear
cell adenocarcinoma of the ovary, endometrium
and vagina, where they are more common.
 Although well known because of its association
with in utero exposure to diethylstilbestrol (DES) in
young women, its peak frequency is at present in the
postmenopausal group. Genomic instability has been
suggested as a mechanism of DES-related
carcinogenesis

A CASE OF CLEAR CELLADENOCARCINOMA IN THE UTERINE CERVIX OF 52-
YEAR-OLD VIRGIN
Young-Lan Lee, MD, Kylie Hae-jin Chang, MD, Min-Sun Kyung, MD, Hong-Bae Kim, MD,
Sung-Ho Park, MD

Serous adenocarcinoma
 A complex pattern of papillae with cellular budding and
the frequent presence of psammoma bodies characterize
serous adenocarcinoma.

Mesonephric adenocarcinoma
 These adenocarcinomas arise from mesonephric remnants
and are most often located in the lateral to posterior wall of
the cervix but may involve the cervix circumferentially.
 They often present as exophytic lesions, they may remain
completely intramural simply expanding the cervical wall.
 Histologically, they are commonly characterized by
tubular glands lined by mucin-free cuboidal epithelium
containing eosinophilic, hyaline secretion in their
lumens in its well differentiated areas or larger glands
showing endometrioid differentiation

Uncommon carcinomas and
neuroendocrine tumours
 Epithelial tumours of the uterine cervix other than
those of squamous or glandular types.
cancer

Uncommon carcinomas and
neuroendocrine tumours
 Adeno squamous carcinoma
a. Glassy cell variant
 Adenoid cystic carcinoma
 Adenoid basal carcinoma
 Neuroendocrine tumours
a. Carcinoid
b. Atypical carcinoid
c. Small cell carcinoma
d. Large cell neuroendocrine c a rc i n o m a
cancer

Adenosquamous carcinoma
 A carcinoma composed of a mixture of malignant
glandular and squamous epithelial elements.
 Glassy cell carcinoma variant: The tumour cells
are large with distinct cell borders and a ground
glass cytoplasm. A prominent eosinophilic
infiltration in the stroma helps to separate the
tumour from non-keratinizing squamous cell
carcinoma.
cancer

cancer

sheets of highly atypical malignant cells
with abundant eosinophilic cytoplasm and
large nuclei with prominent nucleoli
International Agency
For Reaserch On
Cancer – Online Atlas

Adenoid cystic carcinoma
 A carcinoma of the cervix that resembles adenoid cystic
carcinoma of salivary gland origin.
 The characteristic cystic spaces are filled with a slightly
eosinophilic hyaline material or basophilic mucin and
are surrounded by palisaded epithelial cells.
cancer

Microscopic examination
 Tumor showed tumor cells disposed in cribriform as well as in solid pattern.
 The cribriform pattern manifested as a punched-out or “Swiss cheese” arrangement
of tumor cells. surrounding acellular spaces containing hyaline material, the latter
being the reduplicated basement membrane
 The tumor cells were composed of dense basophilic nuclei containing very
inconspicuous nucleoli. Mitotic figures were rarely found.
 The solid pattern was characterized by large masses or nests of uniform basaloid
tumor cells. Occasional prominent areas of necrosis were seen within the central
portions of solid nests.
 The adenoid cystic component was strongly positive for smooth muscle actin while
hyaline stroma was periodic acid-Schiff reaction [PAS] positive.
Adenoid cystic carcinoma of uterine cervix in a young Patient Ankit
Seth, Asha Agarwal1

Adenoid cystic carcinoma of uterine cervix in a young Patient Ankit
Seth, Asha Agarwal1

Adenoid basal carcinoma
 A cervical carcinoma in which rounded, generally
well differentiated nests of basaloid cells show
focal gland formation or sometimes central
squamous differentiation.
 Adenoid basal carcinoma is thought to be derived
from the multipotential basal or reserve cell layer
of the cervical epithelium.
 Clinically, the prognosis is usually favorable.
cancer

Adenoid basal carcinoma
 The histological appearance shows small nests of
basaloid cells, almost always beneath and often arising
from CIN or small invasive squamous cell carcinomas
 The cells are small with scanty cytoplasm and are
arranged in cords and nests with focal glandular or
squamous differentiation.
Adenoid Basal Carcinoma of the Uterine Cervix: Immunohistochemical Study and
Literature Review – Hidento senzaki

Adenoid Basal Carcinoma of the Uterine Cervix: Immunohistochemical Study and
Literature Review – Hidento senzaki

Neuroendocrine tumours
 Neuroendocrine tumors (NETs) are neoplasms that
are composed of cells which have features of both
the endocrine (hormonal) as well as the nervous
system .
 Four subtypes of NEC have been delineated (WHO
Classification) :-
• Small cell neuroendocrine carcinoma
• Large cell neuroendocrine carcinoma
• Typical carcinoid tumor
• Atypical carcinoid tumor
Neuroendocrine tumors of the gynecologic tract: A Society of Gynecologic
Oncology (SGO) clinical document Ginger J. Gardner a, Diane Reidy-Lagunes b, Paola A.
Gehrig

Small Cell Carcinoma
 Small cell carcinoma (SmCC) of the cervix is a rare poorly
differentiated neuroendocrine tumor which shares many
similarities with SmCC of the lung.
 Histologically composed of small blue cells with high
nuclear- cytoplasmic ratio, scant cytoplasm and
markedly atypical hyper chromatic nuclei with finely
stippled chromatin. Nuclear molding is typically present
and nucleoli are inconspicuous.
 SmCC has a high proliferation rate; mitotic activity is
plentiful and there is conspicuous apoptosis as well as
necrosis.
Small Cell Carcinoma of the Uterine Cervix: A Case Report with Emphasis on
Cytopathological Findings Lung-Cheng Huang, Chin-Ping Li, Cheng-Chieh Chen, Chin-
Cheng Lee, Pei-Yi Chu

 The architectural pattern may vary, including sheet-
like, insular or spindled cells architecture. Some
acinar formations may also be seen.
 The diagnosis is confirmed with
immunohistochemical staining: SmCC should be
positive for at least one neuroendocrine marker
(synaptophysin, chromogranin, CD56) and has a
characteristic dot-like cytoplasmic staining with low
molecular weight cytokeratin.
Small Cell Carcinoma of the Uterine Cervix: A Case Report with Emphasis on
Cytopathological Findings Lung-Cheng Huang, Chin-Ping Li, Cheng-Chieh Chen, Chin-
Cheng Lee, Pei-Yi Chu

chromograninIARC-histopathology atlas

LCNEC tumours
 Travis et al have defined the morphological features of
pulmonary LCNEC tumours. Cervical
 tumours exhibit similar characteristics:
a) Cells are of large size and polygonal shape, and have a low nuclear :
cytoplasmic ratio.
b) Nuclei show coarse chromatin and prominent nucleoli.
c) Mitotic activity is in excess of 10 per 10 high-power fields.
d) There is immunohistochemical or
ultrastructural evidence of neuroendocrine
differentiation.
Histopathology Reporting in Cervical Screening – an
Integrated Approach - NHS Cervical Screening
Programme

Large cell neuroendocrine carcinoma. A
The tumour is composed of large cells
with pleomorphic nuclei and frequent
mitotic figures
Small cell carcinoma
– observe size of cell and
nuclear cytoplasmic ratio
Tumors of uterine cervix – international agency for reaserch on cancer

Mesenchymal tumours
 A variety of rare benign and malignant
mesenchymal tumours that arise in the uterine
cervix and which exhibit smooth muscle, skeletal
muscle, vascular, peripheral nerve and other types
of mesenchymal tissue differentiation. Smooth
muscle tumours are the most common.
cancer

 Leiomyosarcoma
 Endometrioid stromal sarcoma,low grade
 Undifferentiated endocervical sarcoma
 Sarcoma botryoides
 Alveolar soft part sarcoma
 Angiosarcoma
 Malignant peripheral nerve sheath tumour
cancer

Sarcoma botryoides or Embryonal
rhabdomyosarcoma
 Rhabdomyosarcoma (RMS) is a malignant tumor which
arises from embryonic muscle cells.
 A tumour composed of cells with small, round, oval or
spindle-shaped nuclei, some of which show evidence of
differentiation towards skeletal muscle cells.
 Sarcoma botryoides is usually reported as a vagina
tumor in the female reproductive tract of infants.
However, it also occurs rarely in the cervix or uterine
fundus.
Sarcoma botryoides (embryonal rhabdomyosarcoma) of the uterine cervix in sisters
Azamsadat Mousavi, Setare Akhavan

The histological findings of sarcoma botryoides of the uterine uterine cervix are similar to the
ones which occur in other organs. These findings consist of rhabdomyoblasts of varying
differentiation dispersed within a loose, myxoid stroma. A distinct "cambium layer" beneath the
epithelium is characteristic of sarcoma botryoides.
Sarcoma botryoides (embryonal rhabdomyosarcoma) of the uterine cervix in sisters
Azamsadat Mousavi, Setare Akhavan

Leiomyosarcoma
cancer

Mixed epithelial and mesenchymal
tumours
 Tumours composed of an admixture of neoplastic
epithelial and mesenchymal elements. Each of these
components may be either benign or malignant
 Carcinosarcoma
 Adenosarcoma
 Wilms tumour
 Adenofibroma
 Adenomyoma
cancer

Carcinosarcoma
 A neoplasm composed of an admixture of malignant
epithelial and mesenchymal elements.
 Malignant Müllerian mixed tumors [MMMTs]
 The epithelial component may be squamous, glandular
(of variable subtype), or undifferentiated.
 The stroma may be undifferentiated sarcoma,
fibrosarcoma, leiomyosarcoma, or contain heterologous
elements (chondrosarcoma or rhabdomyosarcoma).
cancer

Small Cell Neuroendocrine Carcinoma with rhabdomyosarcoma

Carcino sarcoma with clear cell
carcinoma and undifferentiated
sarcoma

Adenosarcoma
 A neoplasm composed of an admixture of benign
epithelial and malignant mesenchymal elements.
cancer

Wilms tumour
 A malignant tumor showing blastema and
primitive glomerular and tubular differentiation
resembling Wilms tumour of the kidney.
cancer

Wilms' tumor of kidney
 Wilms' tumor is a malignant tumor containing
metanephric blastema, stromal and epithelial
derivatives.
 Characteristic is the presence of abortive tubules
and glomeruli surrounded by a spindled cell
stroma. The stroma may include striated muscle,
cartilage, bone, fat tissue, fibrous tissue.
Dysfunction is caused when the tumor compresses
the normal kidney parenchyma.
Wikipedia

Micrograph showing the characteristic triphasic pattern consisting of tubules, solid sheets of
small round cells, and stroma. H&E stain
Wikipedia

High magnification micrograph showing the epithelial component (tubules).
Wikipedia

Adenofibroma
 A mixed neoplasm composed of benign epithelial
and mesenchymal components.
cancer

Adenomyoma
 A tumour composed of a benign glandular
component and a benign mesenchymal
component composed exclusively or
predominantly of smooth muscle. These tumours
are rare within the cervix. A variant is the atypical
polypoid adenomyoma
cancer

Cytology
 A: superficial cells (arrows); B: intermediate cells; C:
parabasal cells; D: metaplastic cells. (obj. 20x)

 Different types of endocervical glandular cells - A and B: secretory
cells; C: ciliated cells; D: naked nuclei of endocervical glandular
cells. (obj. 20x)

Endocervical adenocarcinoma in situ
(AIS): aggregate of atypical
endocervical cells with oval, enlarged
nuclei. Feathering is visible

Cervical cancer

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