Diagnostic difficulty in macroscopically invisible cervical adenocarcinoma: Case report

Cervical adenocarcinomas are the second most common malignant tumours of the cervix after squamous cell carcinoma. Their frequency is reported to be gradually increasing. These tumours are polypoid or papillary in 50%, diffuse or nodular in 15%, and occult (cannot be observed macroscopically) in 10-15% of the cases. We present the pathological features of three cervical adenocarcinoma cases that could not be observed macroscopically but were found by endocervical curettage. Cervicovaginal smears of the cases were prepared by conventional methods and PAP stained. Endocervical curettage and resection materials were reexamined. One patient’s smear material could not be found. No positive findings were detected in the smears of other two cases. The carcinomas could be determined with endocervical curettage in all three cases. All cervixes were sampled and the tissues were processed as the tumour could not be seen macroscopically in hysterectomy materials. Clear cell carcinoma was diagnosed in one case and endocervical mucinous adenocarcinoma in the other two cases. Cervical adenocarcinomas can be occult in some cases and can not be observed during macroscopic examination as in our cases. A large number of paraffin-embedded blocks should be prepared, and if necessary, all cervixes should be processed to find the tumor in such cases. The possibility of diagnosing the tumors which cannot be seen macroscopically and cannot be determined clinically increases if the number of samples taken from the cervix is increased in hysterectomy materials and if conization can be performed after positive ECC which properly performed before endometrial sampling.