IMR Press / EJGO / Volume 40 / Issue 5 / DOI: 10.12892/ejgo4593.2019
Open Access Original Research
Adenocarcinoma of the cervix: its prognosis and difficult pathological diagnosis
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1 Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Japan
2 Department of Cellular and Hist-Pathology, Division of Medical Life Science, Hirosaki University Graduate School of Health Science, Hirosaki, Aomori, Japan
Eur. J. Gynaecol. Oncol. 2019 , 40(5), 728–733;
Published: 10 October 2019

Purpose of investigation: Adenocarcinoma (AC) of the cervix is considered to have a worse prognosis than squamous cell carcinoma (SCC). The incidence of AC of the cervix has increased over the past few years. The WHO’s classification of AC of the cervix was revised in 2014, and usual-type endocervical AC and gastric-type mucinous AC were added as new classes of AC of the cervix. The current study reassessed AC of the cervix in accordance with the new classification and it examined the prognosis for AC of the cervix. Materials and Methods: Subjects were 204 patients who were diagnosed with cervical cancer at this Hospital from 2001 to 2011. Age at onset, histology, FIGO’s staging classification, treatment, and the five-year survival rate for these patients were examined retrospectively. The histopathology of cancer previously identified as AC was reassessed in accordance with the 2014 WHO classification of AC of the cervix. Results: SCC was identified in 165 patients (81%), AC was identified in 22 (11%), adenosquamous carcinoma (ASC) was identified in nine (4%), and some other form of cancer was identified in eight (4%). Median age at onset was 52 years for patients with SCC and 44 years for patients with AC/ASC. According to FIGO’s staging classification, SCC was Stage I in 79 patients (48%) and AC/ASC was Stage I in 21 patients (68%), SCC was Stage II in 41 patients (25%), AC/ASC was Stage II in five patients (16%), SCC was Stage III in 28 patients (17%), AC/ASC was Stage III in one patient (3%), SCC was Stage IV in 16 patients (10%) and AC/ASC was Stage IV in four patients (13%). The five-year survival rate (Kaplan-Meier method) was 89.3% for patients with SCC undergoing initial surgery and 91.7% for patients with AC/ASC undergoing initial surgery. The five-year survival rate for patients undergoing initial surgery did not differ significantly (log-rank test, p=0.84). The 5-year survival rate was 92% for patients with Stage I-II AC/ASC who underwent surgery and 50% for patients with Stage I-II AC/ASC who received radiation therapy (including concurrent chemotherapy and radiation therapy). The five-year survival rate for patients with Stage I-II AC/ASC differed significantly depending on whether the patient underwent surgery or not (p < 0.02). Reassessment of AC resulted in a different diagnosis in eight (38%) of 21 patients with AC. Reassessment in this study resulted in six patients who were diagnosed with endometrioid AC all being diagnosed with usual-type endocervical AC instead. Conclusion: AC/ASC is considered to have a poor prognosis, but the current results suggested that surgery can result in a good prognosis if lesions can be removed. The histopathologic subtype of AC is often determined by a diagnostician, and this determination is difficult.

Adenocarcinoma of the cervix
Usual-type endocervical adenocarcinoma
Five-year survival rate
Figure 1.
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