Thread by @TristanRutland7, Cervix, Adult#gynpath #surgpath #pathtwitter Question:Base on initial image, what type of cells [...]

Tristan D Rutland

TristanRutland7

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Cervix, Adult

#gynpath #surgpath #pathtwitter

Question:

Base on initial image, what type of cells could these be in the stroma?

PASD

Pancytokeratin

CK7/CK20

CDX2

Question:

Based on the limited immunohistochemistry supplied, what type of signet-ring carcinoma would you favour?

PAX-8

Diagnosis:

Metastatic gastric adenocarcinoma (signet ring cell carcinoma)

(Patient had a past Hx of gastric carcinoma).

#GIpath

(Colleagues case)

Question

Which of the following organs is more likely to have is metastasis?

1/ Metastatic disease to the cervix and uterus is uncommon, with the more common sites being the ovary or vagina.

2/ Direct spread of an endometrial carcinoma is more common than metastatic disease in the cervix https://pubmed.ncbi.nlm.nih.gov/29750707/

Secondary Tumors of the Gynecologic Tract: A Clinicopathologic Analysis - PubMed

Although the spread of extragenital tumors to individual female genital tract organs, particularly the ovary, has been much studied, histologic data with regard to secondary tumors involving the...

https://pubmed.ncbi.nlm.nih.gov/29750707/

True or false?

CDX-2 can be positive in endocervical carcinomas but not in endometrioid carcinomas.

3/ CDX-2 is a transcription factor that is important in the development of the intestinal tract.

4/ Other tumours shown to occasional express it are endometrioid, ovarian mucinous and endocervical* carcinomas.

*(not limited to gastric type) https://pubmed.ncbi.nlm.nih.gov/18753946/

Comprehensive evaluation of CDX2 in invasive cervical adenocarcinomas: immunopositivity in the...

CDX2 is a member of the caudal-related homeobox gene family that is expressed during the normal development of the intestinal tract. In addition to staining adenocarcinomas of the alimentary system,...

https://pubmed.ncbi.nlm.nih.gov/18753946/

True or false?

PASD is useful in telling muciphages from signet-ring cells.

5/ As much as it pains me to say, PASD is of limited value here as muciphages can be positive (hints in the name!).

6/ Little bit off topic, but signet-ring cell change (i.e. benign change) in the stomach can be confused with gastric ca https://pubmed.ncbi.nlm.nih.gov/15252323/

Signet-ring cell change in acute erosive gastropathy - PubMed

Signet-ring cell change in acute erosive gastropathy

https://pubmed.ncbi.nlm.nih.gov/15252323/

True or false?

Lastly, primary signet ring carcinoma of the cervix is MORE COMMON that a deposit of metastatic gastric carcinoma?

7/ Primary signet-ring cell carcinoma of the cervix is very rare, with metastasis from a primary gastric tumour being more likely (still rare though).

8/ Care needs to be taken as CDX-2 and CK20 can be positive in both.

9/ History is super important. https://pubmed.ncbi.nlm.nih.gov/20173504/

Primary signet-ring cell carcinoma of the cervix: case report and review of the literature - PubMed

Mucinous adenocarcinoma of the cervix has 5 subtypes: endocervical, intestinal, signet-ring cell, minimal deviation, and villoglandular. There are only rare reports of primary signet-ring cell...

https://pubmed.ncbi.nlm.nih.gov/20173504/

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