Fresia Juwitasari Wongkar¹, Ong Tjandra² 

¹Department of Anatomical Pathology, Bethsaida Hospital, Tangerang, Indonesia 

²Department of Obstetrics and Gynaecology, Bethsaida Hospital, Tangerang, Indonesia 

 

INTRODUCTION: Adenocarcinoma in situ (AIS) is sometimes difficult to differentiate from pattern A (non-destructive) endocervical adenocarcinoma. Even among gynecologic pathologists, there is poor interobserver agreement.¹ Rare cases of metastasis to the ovary have been reported in AIS and pattern A endocervical adenocarcinoma.² 

 

CASE DESCRIPTION: A 53-year-old woman presented with postmenopausal vaginal bleeding. Cervical biopsy revealed endocervical AIS. Patient underwent a total hysterectomy and bilateral salpingo-oophorectomy. Examination of the entire cervix revealed endocervical AIS with a focal area concerning for pattern A endocervical adenocarcinoma, usual type. Both ovaries and fallopian tubes showed borderline-like tumors with numerous apical mitoses resembling cervical lesions. No lesions were found in the endometrium. P16 staining showed diffuse and strong positivity in both cervical and ovarian tumors. These findings indicated HPV-related tumors and confirmed that the ovarian and tubal tumors were metastases from the endocervical tumor. 

CONCLUSION: The mechanism of AIS spreading to the ovaries is not yet fully understood, but it is thought to occur via pagetoid spread through the fallopian tubes, with or without involvement of the endometrium.³ Although rare, pathologists must be able to ecognize ovarian involvement in AIS and pattern A endocervical adenocarcinoma, particularly when no gross lesions are visible in the cervix. 

 

Keywords : Adenocarcinoma insitu, cervix, ovarian metastases

 

Statement of Originality: We declare that the manuscript represent our original idea and contribution. We acknowledge that it has not been previously published elsewhere. 

 

REFERENCES 

1. Parra-Herran, C., Taljaard, M., Djordjevic, B. et al. Pattern-based classification of invasive endocervical adenocarcinoma, depth of invasion measurement and distinction from adenocarcinoma in situ: interobserver variation among gynecologic pathologists. Mod Pathol. 2016; 29: 879–892. 

2. Neil AJ, Li YY, Hakam A, Nucci MR, Parra-Herran C. Pattern A endocervical adenocarcinomas with ovarian metastasis are indolent and molecularly distinct from destructively invasive adenocarcinomas. Histopathology. 2024 Jan; 84(2):369-380. 

3. Horn L-C, Höhn AK, Stark S, et al. Endocervical adenocarcinoma in situ (AIS) with ovarian and pulmonary involvement: report of a case and review of the literature suggesting a "seed and soil hypothesis". J Cancer Res Clin Oncol 2019;145:2061–9.