The expression of epithelial specific antigen in cervical intraepithelial neoplasia and adenocarcinoma

There is a spectrum of changes described as cervical glandular intraepithelial neoplasia (CGIN) with adenocarcinoma in situ (AIS) considered to represent the most severe lesion in that spectrum. Although there is evidence to suggest a progression of CGIN to AIS and to invasive adenocarcinoma, the natural history of these potential precursor lesions has not been fully elucidated. The aim of this project was to establish the relationship of endocervical glandular intraepithelial neoplasias to uterine endocervical adenocarcinoma. Our study included 40 cases of glandular lesions of the cervix (15 cases of endocervical glandular intraepithelial neoplasia, eight of adenocarcinoma in situ and 17 cases of invasive adenocarcinoma). An attempt was made to examine the immunohistochemical localization of epithelial specific antigen (ESA) in those lesions and compare the results with ten cases of normal endocervical epithelium. ESA showed positive staining of the basolateral membrane of endocervical cells in the normal endocervix. The expression of ESA was found to increase from the basolateral to the diffuse cytoplasmic membrane in 12 out of 15 cases of CGIN (80%), in seven out of eight cases of AIS (84%) and in all of the 17 invasive adenocarcinomas (100%). This finding indicates that ESA is a useful marker in the diagnosis of glandular intraepithelial neoplasia and suggests that CGIN and AIS may be precursor lesions of cervical adenocarcinoma.