[Endocervical adenocarcinoma--a current diagnostic problem]

Abstract

Adenocarcinomas currently account for 15-20% of all invasive carcinomas of the uterine cervix in developed countries. The tumor is asymptomatic in up to 20% of the cases and is usually discovered as result of abnormal Pap smears. Cytology smears however are relatively ineffective in detecting of the cervical adenocarcinoma and its precursors. Today, more effective methods are being implemented for the obtaining and interpretation of cytology smears such as the "liquid based Pap", the "Thin Prep imaging syst". This is required also due to the paucity of trained cytotechnicians and cytopathologists. The introduction of computer assisted system for screening raises the effectiveness of detecting LSIL and HSIL to 37% and 42% respectively The problem however with the diagnosis of cervical adenocarcinoma remains more complicated even with the introduction of the above mentioned techniques for a number of reasons. For instance, there are some morphological differences which delineate it from the squamous carcinoma. In everyday practice the pathologist is faced with the following more important issues surrounding the histologic diagnosis of the cervical adenocarcinoma: (1) the recognition of preivasive glandular lesions; (2) the distinction of preinvasive from invasive adenocarcinoma; (3) the definition and significance of microinvasive adenocarcinoma; (4) the recognition of benign lesion that may mimic adenocarcinoma; (5) the identification and behavior of the most common types of invasive adenocarcinomas. To successfully carry out these tasks the pathologist needs: a good knowledge of the above mentioned problems and a good command of modern ancillary techniques. This paper discusses also some etiologic and risk factors such as sexual activity, parity, smoking and using of oral contraceptives. Particular attention is focused to HPV infection as etiological and diagnostic problem and to distinction of the preinvasive and microinvasive forms of adenocarcinoma.