The Spectrum of Cervical Glandular Neoplasia and Issues in Differential Diagnosis - Essay Example

Review of the Article d, “The Spectrum of Cervical Glandular Neoplasia and Issues in Differential Diagnosis” Review of the Article Titled, “The Spectrum of Cervical Glandular Neoplasia and Issues in Differential Diagnosis” Synopsis of the Article With the increasing prevalence of cervical cancer, pathologists and cytotechnologists have been striving to define diagnostic procedures of identifying either premalignant or malignant glandular lesions found in the cervix. Identifying these malignant lesions of the cervix is key ascertaining a positive diagnosis of cervical cancer. Notably, the focus of pathologists has been identifying the invasive endocervical adenocarcinoma. The challenge in achieving this is the presence of benign and lesions that mimic malignant adenocarcinoma. These malignant mimics and different types of benign tumours exhibit numerous morphological features that mislead and confuse pathologists who are making efforts by identifying the invasive endocervical adenocarcinoma. The authors of this article seek to present a detailed analysis of how to distinguish the endocervical adenocarcinoma from the malignant mimics and benign tumours. Being able to differentiate the cancerous adenocarcinoma in situ from the benign tumours is a critical move towards positive diagnosis of the different types of cervical cancer that women suffer. The authors define adenocarcinoma in situ in the first section of the article. This is denoted as a pre-cursor of the invasive cervical adenocarcinoma. According to the authors, there is evidence linking adenocarcinoma in situ and the human papilloma virus (HPV), specifically the HPV type 18. Usually, many patients diagnosed with adenocarcinoma in situ present no visible symptoms and the lesions are only detectable after a specific testing and evaluation. In some cases, though, virginal bleeding may serve as a symptom of the presence of the cancerous lesions (Loureiro & Oliva, 2014). The article describes the architectural and cytologic features used in the diagnosis of adenocarcinoma in situ. Usually, adenocarcinoma exhibits partial or complete involvement of glands in the endocervix. Moreover, adenocarcinoma may exhibit the preservation of normal glandular architecture and may often change to look like normal endocervical epithelium. On the other hand, cytologic features considered during diagnosis include the presence of musin in the cytoplasm as well as the level of stratification, crowding, enlargement or the presence of hyperchromatic nuclei. Other cytologic features that identify adenocarcinoma in situ include frequent mitoses and either small or inconspicuous nucleoli. Sometimes, multiple nuclei, which are smaller, may be present. In a bid to enlighten the reader further, the article discusses where adenocarcinoma in situ is located. Evidently, the article highlights that research has revealed that the transformation zone in the cervix or the upper parts of the endocervical canal are locations where adenocarcinoma in situ is found (Loureiro & Oliva, 2014). In some cases, it affects both the surface epithelium and the endocervical glands. The article point out that adenocarcinoma in situ may sometimes limit itself to the endocervical glands. The article then focuses on describing the different subtypes of adenocarcinoma in situ. The described subtypes include the usual adenocarcinoma in situ (endocervical), intestinal, tubal, endometrioid, tubal metaplasia, adenosquamous carcinoma in situ, and finally the stratified mucin-producing intraepithelial lesion (SMILE). The next section of the article discusses the differential diagnosis of adenocarcinoma in situ and the benign tumours (Raspollini et al, 2007). The authors give attention to a detailed discussion of adenocarcinoma in situ versus benign mimics. Under this subtitle, the authors focus on several pseudoneoplastic lesions. These include reactive glandular atypia, mitotically active endocervical glands, endometriosis, intestinal metaplasia, Arias-Stella reaction, tubal metaplasia, mesonephric remnants, and atypical oxyphilic metaplasia (Loureiro & Oliva, 2014). Each of these benign mimic is described in details in a bid to highlight the differences from adenocarcinoma in situ, which can be critical in diagnosis. Adenocarcinoma in situ is also compared to the squamous metaplasia carcinoma in situ (SMILE) (Schneider, 2011). Moreover, under differential diagnosis, the authors have also described the relationship between endocervical glandular dysplasia. This is identified as a relationship, which has caused controversy because the endocervical glandular dysplasia is used in reference to glandular abnormalities in the endocervix, which are closely related to adenocarcinoma in situ (Raspollini et al, 2007). However, there is no much resemblance. Adenocarcinoma in situ is also contrasted with the early invasive adenocarcinoma. The authors highlight that there is an existing debate regarding the definition of adenocarcinoma in situ and the early invasive adenocarcinoma (Schneider, 011). However, pathologists have focused on describing the morphological features that differentiate the two. A detailed description of how to differentiate the two is presented in a bid to clear the existing confusion (Loureiro & Oliva, 2014). The focus of the article then shifts to the description of invasive endocervical adenocarcinoma. It emerges that the recent past has registered higher rates of prevalence of cervical adenocarcinoma in women. The increase is attributed to higher percentages of incidence coupled with decreasing rates of the invasive squamous cell carcinoma. The authors reveal that most of the cervical adenocarcinomas have a close relationship with the HPV virus. HPV 16 and 18 are more likely to be detected alongside cervical adenocarcinomas (Schneider, 2011). In most cases, virginal bleeding is the most outstanding symptom indicating the presence of cervical adenocarcinoma. Endocervical adenocarcinomas fall under different categories, namely usual, endometrial, mucinous, well-differentiated villoglandular papillary adenocarcinoma, intestinal adenocarcinoma, clear cell, serous, mesonephric, and gastric. Under a subheading of the subtypes, each of these categories is described in details. After the description, the article focuses on the differential diagnosis of the different subtypes. This includes both morphological and cytologic features that define the different types of cervical adenocarcinoma (Loureiro & Oliva, 2014). The article offers detailed attention to the description of differential diagnosis of cervical adenocarcinoma coupled with illustrations in a bid to highlight the differences critical for identification. The authors tackle each of the subtypes independently presenting an in depth description of different tests that would help pathologists in differentiating the different types. Notably, each description focuses on highlighting the symptoms associated with each subtype, the existing relationship with the HPV virus, architectural features, as well as cytological features. The rest of the description defines techniques that have been used to aid differential diagnosis (Raspollini et al, 2007). Attention is also given to the differential diagnosis of endocervical adenocarcinoma versus the gland and the non-glandular components. Other categories described include the adenosquamous carcinoma, adenoid carcinoma, and adenoid cystic carcinoma. Notably, the authors have made efforts of including the differential diagnosis of all the different types of cervical adenocarcinomas and the benign mimics, which are easily confused (Loureiro & Oliva, 2014). Why I chose the Article The choice for this article was motivated by the fact that cervical cancer has registered an increased prevalence in the last few decades. With the increasing prevalence, there is a salient need for a confirmatory positive test that identifies the types of tumours associated with cervical cancer. Worth noting is the fact that the cervix is prone to the development of other benign tumours that lead to a confusion in diagnosis. The confusion results because of the morphological and cytologic similarities between the cervical adenocarcinoma associated with cervical cancer and the numerous benign mimics that have been categorized. This article offers answers to many of the questions that have been bothering pathologists and other specialists in their efforts to identify cervical adenocarcinoma. Differential diagnosis of the cervical adenocarcinoma from other closely related benign mimics is of critical importance if cervical cancer issues are to be addressed promptly. Despite the need for relevant information regarding differential diagnosis, many pathologists have been struggling to rely on the minimal information available (Raspollini et al, 2007). This article offers a detailed description of the differential diagnosis of the different subtypes of cervical adenocarcinoma. Since it presents a description of the related symptoms as well as histological features, the article proves to be invaluable to many cytogenetists and pathologists. Conducting Papanicolaou smears is the common test used in the identification of cervical adenocarcinoma in women who are prone to cervical cancer. Without a detailed understanding of the morphological and cytologic features that define the different types of cervical adenocarcinomas, it proves difficult to accurately determine whether a woman is prone to cervical cancer. The need to determine the susceptibility of a woman to cervical cancer early enough cannot be overemphasized considering the high mortality rates registered by this type of cancer (Raspollini et al, 2007). Moreover, the fact that only early intervention can serve to save the situation necessitates the significance of accurate differential diagnosis. This article comes in to fill in the existing need for guidelines in the differential diagnosis of different subtypes of cervical adenocarcinoma. Most importantly, the article tackles the differential diagnosis of adenocarcinoma in situ, which is the precursor of the invasive cervical adenocarcinoma. Therefore, pathologists can rely on the knowledge presented in this article to ensure that they can diagnose cervical adenocarcinoma in its early stages (Schneider, 2011). This article offers critical information as well as an accurate description of how pathologists can differentiate the adenocarcinoma in situ and cervical adenocarcinoma from the numerous benign mimics. Being able to differentiate the two categories is important in helping curb the increasing rate of wrong diagnosis. Some women with the benign tumours, which closely mimic the invasive cervical adenocarcinoma, have had to live with the fear of cervical cancer while in the real sense, their tumours are only benign and not malignant. Such confusion in diagnosis results from the scarcity of information regarding the morphological and cytologic differences of cervical malignant and benign tumours. With the guidelines presented in this article, wrong diagnosis will become outdated. Therefore, selection of the article was based on the criticality of the information and findings presented by the authors in helping pathologists to accurately diagnose cervical adenocarcinomas (Schneider, 2011). What I learned from this Article This article served to enlighten me on the existing subtypes of adenocarcinoma in situ. Although I had prior knowledge on adenocarcinoma in situ, I was not aware of the numerous subtypes that have been identified. Moreover, the article helped me gain familiarity with the benign mimics that pathologists easily confuse with the adenocarcinoma in situ (Schneider, 2011). The guidelines on differential diagnosis served as invaluable information in an era whereby accurate diagnosis of cervical cancer has proven to be difficult. The article also highlighted the differences between adenocarcinoma in situ and invasive cervical adenocarcinoma. It became evident that adenocarcinoma in situ is the precursor of cervical adenocarcinoma. The article also helped me to understand the existing controversy in the diagnosis of cervical adenocarcinoma and the numerous benign mimics (Schneider, 2011). The knowledge presented in the article is critical for upcoming pathologists and cytotechnologists as it is central to their practice. The topic on differential diagnosis of cervical adenocarcinoma is appropriate for class presentation because students need to understand the existing controversy in the diagnostic procedures. Moreover, this article will help them understand that it is possible to carry out an accurate differential diagnosis based on the morphological and cytologic features of the different subtypes of cervical adenocarcinoma (Raspollini et al, 2007). Notably, this article will help the class form informed opinions regarding the existing controversy and medical dilemma of diagnosing cervical adenocarcinomas. References Loureiro, J., & Oliva, E. (2014). The Spectrum of Cervical Glandular Neoplasia and Issues in Differential Diagnosis. Archives Of Pathology & Laboratory Medicine, 138(4), 453-483. doi:10.5858/arpa.2012-0493-RA. Raspollini, M., Fambrini, M., Marchionni, M., Baroni, G., & Taddei, G. (2007). In situ adenocarcinoma and squamous carcinoma of uterine cervix. Pathological and immunohistochemical analysis with cytokeratin 13. European Journal Of Obstetrics And Gynecology, 134249-253. Schneider, V. (2011). Cytopathology of adenocarcinoma in situ of the endocervix and its differential diagnosis. Monographs In Clinical Cytology, 2026-33. doi:10.1159/000319854. Read More