HPV-Independent Gastric Type Adenocarcinoma of the Uterine Cervix presenting as Ovarian Masses

A Case Report and Review of Literature

Keywords: cervical adenocarcinoma, gastric-type cervical adenocarcinoma, hpv-independent cervical adenocarcinoma


Adenocarcinoma, HPV-independent, gastric type of the uterine cervix comprises only 10-15% of all cervical adenocarcinomas. A rare case of which, with metastasis to the uterine corpus and bilateral ovaries, is described. A 43-year-old female (G0P0) presented with menorrhagia and right flank pain radiating to the hypogastrium. Physical examination revealed an immovable, tender mass at the right lower quadrant with a nodular, firm cervix. Transabdominal ultrasound revealed multiseptated ovarian masses. The right and left ovaries were sent for frozen section and was diagnosed as Mucinous Cystadenoma and Mature Cystic Teratoma, respectively. Hysterectomy revealed a detached and fragmented cervix with irregular, abnormally shaped glands lined by a single layer of columnar cells with bland, basally located nuclei and clear cytoplasm associated with desmoplasia, findings which were also seen in the endomyometrium and ovaries. These tumor cells were CK7 positive and negative for ER, PR, CK20 and CDX2. The patient died six months after surgery. The presence of benign appearing glands is a diagnostic challenge. Despite the appearance, they may be malignant and should be investigated rigorously.


Download data is not yet available.

Author Biographies

Joseph Antoine Chatto, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines

Medical Officer IV, Department of Pathology

Annette Salillas, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines

Chairman, Department of Pathology


Nishii Y, Fukuda T, Imai K, et al. Minimal deviation mucinous adenocarcinoma of the uterine cervix that proved difficult to differentiate from endometrial cancer: A case report. Oncol Lett. 2014;8(6):2481-4. https://pubmed.ncbi.nlm.nih.gov/ 25364411. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214510. https://doi.org/10.3892/ol.2014.2532.

Kushwaha R, Yadav YK. A rare case of minimal deviation mucinous adenocarcinoma of the uterine cervix and review of literature. Clin Cancer Inves J. 2013;2(4):362-4. https;//doi.org/ 10.4103/2278-0513.121549.

Silverberg SG, Hurt WG. Minimal deviation adenocarcinoma (“adenoma malignum”) of the cervix: a reappraisal. Am J Obstet Gynecol. 1975;121(7):971-5. https://pubmed.ncbi.nlm.nih.gov/1115185. https://doi.org/10.1016/0002-9378(75)90920-5.

Wilbur DC, Colgan TJ, Ferenczy AS, et al. Glandular tumours and precursors. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH, eds. WHO classification of female reproductive organs, 4th ed. Lyon: IARC; 2014.

Park KJ, Kong CS, Ohishi Y, Parra-Herran C. Adenocarcinoma, HPV-independent, gastric type, of the uterine cervix. In: Herrington CS, ed. WHO classification of tumours female genital tumours 5th ed. Lyon: IARC; 2020; 374-5.

Zhang Y, Liang L, Euscher ED, Liu J, Ramalingam P. Gastric-type mucinous adenocarcinoma of the uterine cervix with neoadjuvant therapy mimicking clear cell carcinoma. Int J Clin Exp Pathol. 2015;8(9):11798-803. https://pubmed.ncbi.nlm.nih.gov/26617929. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637745.

Chang E, Lee E, Kim K, et al. Minimal deviation adenocarcinoma, mucinous type, of the uterine cervix - report of a case with extensive metastasis to the uterine corpus and bilateral adnexae. Korean J Pathol. 2004;38:121-5. http://www.koreanjpathol.org/upload/journal/2004/2004_0121.pdf.

Mutter G, Prat J. Pathology of the female genital tract, 3rd ed. London: Churchill Livingstone Elsevier;2014.

Fletcher C. Diagnostic histopathology of tumors, 4th ed, vol. 1. Philadelphia: Elsevier; 2013.

Jie C, Shen Z, Hui Z, Jin-Xiao L, Zhong-Qiu. Clinical analysis of minimal deviation adenocarcinoma of the cervix: a report of five cases. Ai Zheng. 2008;27(12):1310-4. https://pubmed.ncbi.nlm.nih.gov/19080000.

Villegas-Cruz C, Arias AL, Montiel DP, Chanona-Vilchis J, Montalvo LAH, de Leon DC. Minimal deviation adenocarcinoma associated with high grade squamous cervical intraepithelial neoplasia. Obstet Gynecol Cases Rev. 2015;2:4. https://clinmedjournals.org/articles/ogcr/ogcr-2-047.pdf.

Kwon KW, Chin S, Kim HK, Koh ES, Kim KR, Nam KH. Minimal deviation endometrioid adenocarcinoma of the uterine cervix: a case report. Kor J Pathol. 2008;42:240-3. http://www.koreanjpathol.org/upload/journal/2008/2008_0240.pdf.

Senar AC, Paño B, Saco A, Nicolau C. Magnetic resonance imaging of adenoma malignum of the uterine cervix with pathologic correlation: a case report. Radiol Case Rep. 2016;(11):323-7. https://pubmed.ncbi.nlm.nih.gov/27920853. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128363. https://doi.org/10.1016/j.radcr.2016.08.008.

Mills K, Shuen P, Zolis L. Adenoma malignum presenting with profound yyponatremia. J Obstet Gynaecol Can. 2015;37(7):624-7. https://pubmed.ncbi.nlm.nih.gov/26366819. https://doi.org/10.1016/S1701-2163(15)30200-0.

Tsuda H, Mikami Y, Kaku T, et al. Interobserver variation in the diagnosis of adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. Pathol Int. 2003;53(7):440-9. https://pubmed.ncbi.nlm.nih.gov/12828609. https://doi.org/10.1046/j.1440-1827.2003.01497.x.

Stolnicu S, Barsan I, Hoang L, et al. International Endocervical Adenocarcinoma Criteria and Classification (IECC): a new pathogenetic classification for invasive adenocarcinoma of the endocervix. Am J Surg Pathol. 2018;42(2):214-26. https://pubmed.ncbi.nlm.nih.gov/29135516. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5762258. https://doi.org/10.1097/PAS.0000000000000986.

Park KJ. Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification. Histopathology 2020, 76(1):112-7. https://pubmed.ncbi.nlm.nih.gov/ 31846527. https://doi.org/10.1111/his.13995.

McLuggage, WG. Immunohistochemistry in the differential diagnosis of female genital tract pathology. In: Nucci M, et al. Gynecologic pathology: a volume in the series: foundations of diagnostic pathology. Elsevier Churchill Livingstone; 2009.

Moat M, O’Donnell RL, McCluggage WG, Ralte A, Edmondson RJ. Gastric-type adenocarcinoma of the cervix in a patient with Lynch syndrome: a case report. Gynecol Oncol Rep. 2014;10:41-3. https://pubmed.ncbi.nlm.nih.gov/26082936. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458744. https://doi.org/10.1016/j.gynor.2014.03.002.

Kusanagi Y, Kojima A, Mikami Y, et al. Absence of high-risk human papillomavirus (hpv) detection in endocervical adenocarcinoma with gastric morphology and phenotype. Am J Pathol. 2010;177(5):2169-75. https://pubmed.ncbi.nlm.nih.gov/20829441. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966776. https://doi.org/10.2353/ajpath.2010.100323.

Kuragaki C, Enomoto T, Ueno Y. Mutations in the STK11 Gene Characterize Minimal Deviation Adenocarcinoma of the Uterine Cervix. Laboratory Investigation. 2003;83(1);35-45. https://pubmed.ncbi.nlm.nih.gov/20416098. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877003. https://doi.org/10.1186/1746-1596-5-25.

Gong L, Zhang WD, Liu XY, et al. Clonal status and clinicopathological observation of cervical minimal deviation adenocarcinoma. Diagn Pathol. 2010;5:25. https://pubmed.ncbi.nlm.nih.gov/20416098. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877003. https://doi.org/10.1186/1746-1596-5-25.

He M, Jackson C, Gubrod R, et al. KRAS mutations in mucinous lesions of the uterus. Am J Clin Pathol. 2015;143(6):778-4. https://pubmed.ncbi.nlm.nih.gov/25972319. https://doi.org/10.1309/AJCP69RBNUHHOJRI.

Banerjee P, Mitra PS, Bhowmik P, Soreng PS, Mukherjee B, Choudhury S. Minimal deviation adenocarcinoma (“adenoma malignum”) of the cervix: a diagnostic dilemma. IOSR J Dental Med Sciences. 2013;9(4):12-4. http://www.iosrjournals.org/iosr-jdms/papers/Vol9-issue4/C0941214.pdf.

Lin M, Kim K, Ro J. Gastric-type endocervical adenocarcinoma: review of clinicopathologic characteristics and recent advances. J Gynecol Res Obstet. 2020;6(3):72-5. https://doi.org/10.17352/jgro.000091.

Nishio S, Mikami Y, Tokunaga H, et al. Analysis of gastric-type mucinous carcinoma of the uterine cervix- An aggressive tumor with a poor prognosis: A multi-institutional study. Gynecol Oncology. 2019;153(1):13-9. https://pubmed.ncbi.nlm.nih.gov/30709650. https://doi.org/10.1016/j.ygyno.2019.01.022.

How to Cite
Chatto, J. A., & Salillas, A. (2021). HPV-Independent Gastric Type Adenocarcinoma of the Uterine Cervix presenting as Ovarian Masses: A Case Report and Review of Literature. PJP, 6(1), 50-55. https://doi.org/10.21141/PJP.2021.06