Glassy cell features in adenosquamous carcinoma of the uterine cervix. Histologic, ultrastructural, immunohistochemical, and clinical findings

Abstract

Glassy cell features (GCF) were identified as composing a predominant pattern (more than 85% of histology) in six cases and a focal pattern (33-85% of histology) in 10 cases of a series of 53 adenocarcinomas (AC) and adenosquamous carcinomas (ADSQ) of the uterine cervix. In three cases examined ultrastructurally, GCFs correlated with many cytoplasmic polyribosomes and abundant rough endoplasmic reticulum, but Golgi complexes and tonofilaments were scant and intracytoplasmic lumina were absent. Intracellular mucin was present in the areas showing GCFs of four ADSQs with predominant GCFs and six ADSQs with focal GCFs. Two of three cases examined ultrastructurally showed intracellular electron-dense material that corresponded to mucin secretory material. Immunohistochemical studies of the six ADSQs with predominant GCF cases showed the following pattern of reactivity: monoclonal carcinoembryonic antigen (CEA), 2 of 6 cases; polyclonal CEA, 3 of 6; CA 125, 0 of 6; CA 19-9, 0 of 6; placental alkaline phosphatase, 0 of 6; and vimentin, 1 of 6. Focal GCF areas showed monoclonal CEA, 4 of 9 cases; polyclonal CEA, 3 of 9; vimentin, 4 of 9; while CA 125, CA 19-9, and placental alkaline phosphatase were negative in areas of GCFs. One of three patients with ADSQ with predominant GCFs and five of nine patients with ADSQ with focal GCFs with at least 1 year of follow-up were disease free. No association between GCFs (combined focal and predominant) and recurrent disease was present when compared to the other 29 AC and ADSQ patients with follow-up. Recurrent disease in our series of AC and ADSQ was only associated with stage III or IV disease at presentation (P less than 0.001). There was no association with adenosquamous histology, histologic grade, lymphatic invasion, or age. There were insufficient cases of ADSQ with predominant GCFs with follow-up to evaluate fully prognostic significance of this subgroup. Our study suggests that GCFs are part of the spectrum of differentiation in ADSQ of the cervix rather than a distinct histologic type of carcinoma with unique clinical significance.