The Clincal Analysis Of Five Cases Of Gastric-type Endocervical Adenocarcinoma And Literature Review

Objective: To study the clinical and pathological characteristics,diagnosis,treatment and prognosis of the gastric-type endocervical adenocarcinoma(GAS).Methods: A retrospective analysis was performed in five cases of GAS who were admitted to the First Affiliated Hospital of Nanjing Medical University from Jan.2012 to Jan.2016,and the clinical and pathological characteristics,diagnosis,treatment and prognosis of GAS were summarized.Results: Totally five patients,the mean age was(46.40±11.28)years(ranging 32-61 years).The main clinical manifestations were vaginal drainage and pelvic pain.Pelvic magnetic resonance imaging(MRI)showed a high signal on T2 WI,exhibiting a multicystic appearance,and heterogeneous enhancement between the cysts.Ultrasonography showed enlargement of the cervix and a polycystic or honeycomb mass,with rich blood supply signals.The positive expression rate of the cervical cytology was 20%(1/5)in GAS.None of five patients were infected with HPV.Preoperative diagnosis was three patients,including one in cervical biopsy,one in conization of the cervix,and one in fractional curettage.Two patients were accidentally diagnosed with GAS intraoperatively or postoperatively.Radical hysterectomy,as well as pelvic lymphadenectomy and paraortic lymphadenectomy,was performed on the five patients.Cervical expansion and multiple cystic lesions were observed in surgical specimens.Three patients had lymph node metastasis,and two patients had ovarian mucinous metastasis.The pahotlogical features were massive mucoid glands invade cervical deep muscularis and vessles,or even nervous tissue.Immunohistochemical staining features are PAX8(+),CK7(+),MUC6(+),CEA(+),Ki-67(+),CK20(+),ER(-),PR(-),P16(-),CA125(-)and p53-negative or focal.All five cases were followed up,mean follow-up period being 11.8±6.9(3-21)months.One relapsed twelve months after the surgery,and one lost control of advanced cervical cancer,with liver metastasis five months after the surgery.Conclusions: The main clinical manifestations are vaginal drainage and pelvic pain.Clinical symptoms and signs is not typical,and the diagnosis is difficult.Radical hysterectomy and pelvic lymphadenectomy are the main treatment of GAS.Early diagnosis and early treatment could obtain results.