Gastric-type Endocervical Adenocarcinoma: An Aggressive Tumor With Unusual Metastatic Patterns and Poor Prognosis

Am J Surg Pathol. 2015 Nov;39(11):1449-57. doi: 10.1097/PAS.0000000000000532.


Gastric-type adenocarcinoma of the uterine cervix (GAS) is a rare variant of mucinous endocervical adenocarcinoma not etiologically associated with human papillomavirus (HPV) infection, with minimal deviation adenocarcinoma (MDA) at the well-differentiated end of the morphologic spectrum. These tumors are reported to have worse prognosis than usual HPV associated endocervical adenocarcinoma (UEA). A retrospective review of GAS was performed from the pathology databases of 3 institutions spanning 20 years. Stage, metastatic patterns, and overall survival were documented. Forty GAS cases were identified, with clinical follow-up data available for 38. The tumors were subclassified as MDA (n=13) and non-MDA GAS (n=27). Two patients were syndromic (1 Li-Fraumeni, 1 Peutz-Jeghers). At presentation, 59% were advanced stage (FIGO II to IV), 50% had lymph node metastases, 35% had ovarian involvement, 20% had abdominal disease, 39% had at least 1 site of metastasis at the time of initial surgery, and 12% of patients experienced distant recurrence. The metastatic sites included lymph nodes, adnexa, omentum, bowel, peritoneum, diaphragm, abdominal wall, bladder, vagina, appendix, and brain. Follow-up ranged from 1.4 to 136.0 months (mean, 33.9 mo); 20/38 (52.6%) had no evidence of disease, 3/38 (7.9%) were alive with disease, and 15/38 (39.5%) died of disease. Disease-specific survival at 5 years was 42% for GAS versus 91% for UEA. There were no survival differences between MDA and non-MDA GAS. GAS represents a distinct, biologically aggressive type of endocervical adenocarcinoma. The majority of patients present at advanced stage and pelvic, abdominal, and distant metastases are not uncommon.

Publication types

  • Multicenter Study

MeSH terms

  • Adenocarcinoma, Mucinous / classification
  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / secondary*
  • Adenocarcinoma, Mucinous / therapy
  • Adult
  • Aged
  • Cell Differentiation
  • Connecticut
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Staging
  • New York City
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Uterine Cervical Neoplasms / classification
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / therapy