Four cases of villoglandular papillary adenocarcinoma and literature review

Objective: To explore the clinical and pathological features, diagnosis and therapy of Villoglandular Papillary Adenocarcinoma (VGPA). Methods: 4 cases of villoglandular papillary adenocarcinoma of uterine cervix admitted from 2001 to 2009 in Children's Hospital, Shanxi Provincial People's Hospital were analysed retrospectively, including detailed clinical data. Results: (1) Most of the tumors were extrinsic type, growing slow, no specificity in clinical manifestations, which were found in the early stage generally. (2) 3 cases were infected by high risk Human Papilloma Virus (HPV), 2 of them were mixed infection, and the FIGO stages were all Ib. (3) The preoperative pathological examinations of 3 cases were inconsistent with the postoperative ones. (4) The postoperative pathological examinations showed that there were different degrees of myometrial invasion, but no lymphatic and vascular metastasis. Immunohistochemical staining showed that CK7, CA72-4, CEA, CA125 and P16 expression were positive in tumor tissues, but ER, PR, P53and Vimentin were negative. (5) One of 4 cases received total hysterectomy and radiotherapy after surgery, and the others accepted wide hysterectomy and pelvic lymph node dissection, but no radiotherapy after operation. All patients were followed up till now, no recurrence. Conclusion: (1) High risk HPV may play a role in the pathogenesis of VGPA. (2) It is difficult to diagnose before surgery only by clinical and routine pathological examination, but combined with immunohistochemistry may help to improve the preoperative diagnosis rate of VGPA. (3) The prognosis may be good, but the lesion is easy to invade the muscle layer, so conservative surgery need to be chosen carefully.