Definition/General
Introduction:
Cervical serous carcinoma is an extremely rare and aggressive variant of cervical adenocarcinoma that morphologically resembles high-grade serous carcinoma of the ovary or endometrium
It typically lacks association with HPV and has poor prognosis.
Origin:
Arises from cervical epithelium with serous differentiation
Shows high-grade nuclear features and complex papillary architecture
Usually not associated with high-risk HPV infection.
Classification:
WHO Classification recognizes serous adenocarcinoma as rare variant of cervical adenocarcinoma
High-grade by definition with aggressive behavior.
Epidemiology:
Extremely rare, <0.5% of cervical adenocarcinomas
Peak incidence 50-70 years (older than typical cervical cancers)
Usually HPV-negative
Very poor prognosis.
Clinical Features
Presentation:
Abnormal vaginal bleeding in postmenopausal women
Advanced stage at presentation common
Rapid clinical progression
Often presents with extrauterine disease.
Symptoms:
Postmenopausal bleeding (most common)
Pelvic pain
Abdominal distension (ascites)
Constitutional symptoms (weight loss, fatigue)
Early metastatic symptoms.
Risk Factors:
Advanced age (>50 years)
Not associated with typical cervical cancer risk factors
No clear HPV association
Genetic predisposition possible.
Screening:
Standard cervical screening less effective due to age group and HPV-negative status
Advanced imaging often shows extensive disease at presentation.
Master Cervical Serous Carcinoma Pathology with RxDx
Access 100+ pathology videos and expert guidance with the RxDx app
Gross Description
Appearance:
Papillary, cauliflower-like mass with friable consistency
Often large at presentation
May show areas of hemorrhage and necrosis
Infiltrative growth pattern.
Characteristics:
Size typically large (>4 cm)
Soft, friable consistency
Gray-white to tan coloration
Complex papillary surface
Extensive hemorrhage and necrosis.
Size Location:
Usually involves entire cervix at presentation
Early extension to parametrium, vagina, and adjacent organs
Peritoneal implants possible.
Multifocality:
Often extensive local and regional involvement
May present with synchronous ovarian or endometrial involvement
Peritoneal carcinomatosis possible.
Microscopic Description
Histological Features:
Complex papillary architecture with irregular branching
High-grade nuclear features with marked pleomorphism
Slit-like spaces and micropapillary pattern
Extensive necrosis and mitotic activity.
Cellular Characteristics:
High-grade nuclei with marked pleomorphism
Prominent nucleoli
High nuclear-cytoplasmic ratio
Bizarre mitotic figures
Extensive apoptosis.
Architectural Patterns:
Complex papillary structures with micropapillary areas
Slit-like glandular spaces
Solid sheets possible
Infiltrative growth pattern.
Grading Criteria:
High-grade by definition
Marked nuclear pleomorphism
High mitotic rate (>20 per 10 HPF)
Extensive necrosis
Architectural complexity.
Immunohistochemistry
Positive Markers:
p53 aberrant (overexpression or null pattern)
WT1 positive
PAX8 positive
CK7 positive
CA125 positive.
Negative Markers:
p16 negative (HPV-negative)
CK20 negative
CDX2 negative
TTF-1 negative
Vimentin variable.
Diagnostic Utility:
p53 aberrant staining pattern diagnostic
WT1 supports serous differentiation
p16 negativity indicates HPV-independent pathway
PAX8 confirms Müllerian origin.
Molecular Subtypes:
HPV-independent serous carcinoma
p53-mutant subtype with aggressive behavior.
Molecular/Genetic
Genetic Mutations:
TP53 mutations (>90% cases)
BRCA1/BRCA2 mutations possible
PIK3CA alterations
Chromosomal instability
No HPV integration.
Molecular Markers:
Aberrant p53 expression
High Ki-67 index (>50%)
Chromosomal instability
Loss of BRCA function possible.
Prognostic Significance:
Extremely poor prognosis
Median survival <2 years
High propensity for peritoneal spread
Chemotherapy resistance common.
Therapeutic Targets:
Platinum-based chemotherapy (similar to ovarian serous carcinoma)
PARP inhibitors if BRCA-deficient
Bevacizumab
Immunotherapy limited efficacy.
Differential Diagnosis
Similar Entities:
Metastatic high-grade serous carcinoma (ovarian, tubal, peritoneal)
Primary endometrial serous carcinoma
Conventional cervical adenocarcinoma.
Distinguishing Features:
Primary cervical: clinical presentation, imaging
Metastatic: multifocal disease, primary site identification
Conventional cervical: p16+, HPV+.
Diagnostic Challenges:
Distinction from metastatic disease crucial
Requires careful clinical and imaging correlation
Origin determination challenging with advanced disease.
Rare Variants:
Mixed serous and endometrioid carcinoma
Serous carcinoma with clear cell features
Micropapillary 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]