Definition/General
Introduction:
Cervical oxyphilic carcinoma is an extremely rare variant of endocervical adenocarcinoma characterized by cells with abundant granular eosinophilic cytoplasm rich in mitochondria (oncocytic cells)
It represents a morphological variant with uncertain prognosis.
Origin:
Arises from endocervical glandular epithelium with extensive oncocytic change
Shows accumulation of abnormal mitochondria in cytoplasm
Variable association with high-risk HPV infection.
Classification:
WHO Classification recognizes oxyphilic/oncocytic adenocarcinoma as rare variant of cervical adenocarcinoma
Defined by >75% oncocytic cells.
Epidemiology:
Extremely rare, <0.1% of cervical adenocarcinomas
Peak incidence 40-70 years (broader age range)
Variable HPV association
Limited data on prognosis.
Clinical Features
Presentation:
Abnormal vaginal bleeding
Cervical mass or thickening
May present as exophytic lesion
Often diagnosed incidentally during routine examination.
Symptoms:
Abnormal vaginal bleeding (intermenstrual, postcoital)
Vaginal discharge
Pelvic discomfort
May be asymptomatic initially
Constitutional symptoms rare.
Risk Factors:
Advanced age (>40 years)
Variable HPV association
Smoking
Family history of cancer possible
No specific risk factors identified.
Screening:
Pap smear may show atypical glandular cells with abundant cytoplasm
HPV testing variable
Colposcopy and biopsy required for diagnosis.
Master Cervical Oxyphilic Carcinoma Pathology with RxDx
Access 100+ pathology videos and expert guidance with the RxDx app
Gross Description
Appearance:
Firm, well-circumscribed to infiltrative mass
Cut surface shows tan-brown to reddish coloration
May have granular appearance due to mitochondrial content.
Characteristics:
Size variable (1-5 cm)
Firm consistency
Tan-brown to reddish color
Granular cut surface
Well-circumscribed or infiltrative borders.
Size Location:
Can arise from any part of cervix
May show superficial or deep invasion
Variable growth patterns possible.
Multifocality:
Usually unifocal lesion
May be associated with conventional adenocarcinoma areas
Mixed patterns possible.
Microscopic Description
Histological Features:
Malignant glands lined by cells with abundant granular eosinophilic cytoplasm
Large nuclei with prominent nucleoli
Variable architectural patterns including glandular, solid, and papillary.
Cellular Characteristics:
Large cells with abundant granular eosinophilic cytoplasm packed with mitochondria
Enlarged nuclei with prominent nucleoli
Oncocytic change prominent.
Architectural Patterns:
Glandular architecture predominant
May have solid or papillary areas
Infiltrative growth pattern
Variable stromal response.
Grading Criteria:
Grading based on nuclear features and architecture
Intermediate to high-grade features typical
Mitotic activity variable.
Immunohistochemistry
Positive Markers:
CK7 positive
PAX8 positive
CEA positive
Mitochondrial markers positive
p16 variable (HPV-dependent).
Negative Markers:
CK20 negative
CDX2 negative
TTF-1 negative
Hepatocyte marker negative
Renal cell carcinoma markers negative.
Diagnostic Utility:
CK7 and PAX8 confirm Müllerian origin
Mitochondrial markers confirm oncocytic nature
p16 variable based on HPV status.
Molecular Subtypes:
HPV-associated and HPV-independent forms possible
Oncocytic variant with mitochondrial accumulation.
Molecular/Genetic
Genetic Mutations:
Variable HPV integration
Mitochondrial DNA mutations possible
Nuclear genetic alterations variable
Limited molecular data available.
Molecular Markers:
Variable HPV DNA detection
Mitochondrial enzyme overexpression
Variable Ki-67 index
p53 alterations possible.
Prognostic Significance:
Uncertain prognosis due to rarity
Stage likely most important factor
Oncocytic change may not significantly alter behavior.
Therapeutic Targets:
Standard cervical cancer treatment protocols
Limited data on response to therapy
Metabolic targeting theoretically possible.
Differential Diagnosis
Similar Entities:
Metastatic oncocytic carcinoma (thyroid, kidney, adrenal)
Cervical adenocarcinoma with degenerative changes
Clear cell carcinoma.
Distinguishing Features:
Primary cervical: clinical presentation, PAX8+
Metastatic thyroid: TTF-1+, thyroglobulin+
Metastatic renal: RCC markers+.
Diagnostic Challenges:
Distinction from metastatic disease crucial
Recognition of true oncocytic change vs
degenerative changes
Assessment of HPV association.
Rare Variants:
Mixed oncocytic and conventional adenocarcinoma
Oncocytic with clear cell features
Pleomorphic oncocytic variant.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]