The pattern is the issue: recent advances in adenocarcinoma of the uterine cervix

In this article, we review a novel risk stratification system for endocervical adenocarcinoma, developed by an international consortium of pathologists after reviewing over 350 such tumors. Their analysis culminated in a three-tiered histopathologic system based on morphologic examination of the tumor, independent of clinical features and stage (depth of invasion). It resulted in better determination of patients' tumors and likelihood of lymph node metastasis as well as aggressive behavior. A non-destructive pattern (that in some cases was in the histologic differential diagnosis with adenocarcinoma in situ) had an indolent behavior and was labeled pattern A. The other two patterns had destructive invasion, one only focally (pattern B) while pattern C showed diffuse destructive invasion. This system can help select appropriate treatment modalities avoiding unnecessary complications. We comment on specifics of this system as well as issues in differentiation of the tumor patterns, its clinical utility and recent advances in the molecular arena.