Endocervical neoplasia: Pathologic updates in diagnosis and prognosis

The diagnosis of adenocarcinoma of the uterine cervix can be challenging due to the varied histologic types different etiologies and their associated biologic behaviors and corresponding clinical management implications. To address these issues a new classification system has been developed and is introduced in the most recent edition of the WHO Classification of Female Genital Tumors. This system is based on morphology and the relationship with human papillomavirus (HPV). All the tumors are now classified into HPV-associated (HPVA) and HPV-independent (HPVI). In addition there are diagnostic pathology related advancements which are able to predict prognosis such as the incidence of lymph node metastasis and the tumor recurrence. These advances include cancer invasive patterns tumor nuclear grade and the status of necrotic tumor debris. This review will discuss endocervical adenocarcinomas (EAC) including their precursors in association with HPV. Instead of discussing each histologic type of ECA individually we group all EACs into four categories based on their dominant growth patterns including glandular papillary mucin producing and solid microscopic appearances. Differential diagnosis and diagnostic pitfalls are addressed in each category. The glandular growth pattern is the most common. In this category location is important to be considered for the differential. The mucin-producing group is comprised by HPVA and HPVI tumors and the differential diagnosis should include metastatic mucinous carcinomas. Serous carcinoma of the uterine cervix no longer exists; however the terminology serous-like adenocarcinoma has been designated to tumors with the serous morphology that are HPV positive. We include this tumor in the papillary architecture category. A solid growth pattern can be found in multiple histologic types of EAC and most of them behave aggressively. Histopathologic parameters with prognostic relevance are also briefly discussed.