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CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 6  |  Page : 565-567  

Glassy cell carcinoma: A rare variant of cervical carcinoma – Case report with review of literature


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Submission10-Jan-2018
Date of Acceptance26-Sep-2018
Date of Web Publication15-Nov-2018

Correspondence Address:
Nidhi Raina
Room No 108, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.MJDRDYPU_5_18

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  Abstract 


Glassy cell carcinoma is a rare clinical entity involving uterine cervix with aggressive course and relatively poor prognosis. It is a poorly differentiated variant of adenosquamous carcinoma. This neoplasm has poor response to radiotherapy and carries worse prognosis than the usual types of adenocarcinoma and squamous cell carcinoma. A case of a 40-year-old female patient is reported and the published literature is reviewed.

Keywords: Adenosquamous carcinoma, cervix, glassy cell carcinoma


How to cite this article:
Raina N, Gulati A, Kaushik R, Rana A. Glassy cell carcinoma: A rare variant of cervical carcinoma – Case report with review of literature. Med J DY Patil Vidyapeeth 2018;11:565-7

How to cite this URL:
Raina N, Gulati A, Kaushik R, Rana A. Glassy cell carcinoma: A rare variant of cervical carcinoma – Case report with review of literature. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2018 Dec 19];11:565-7. Available from: http://www.mjdrdypv.org/text.asp?2018/11/6/565/245430




  Introduction Top


Glassy cell carcinoma (GCC) of the cervix is considered a rare tumor involving the cervix and accounts for around 1% of all cervical cancers. It was originally described in the cervix by Glucksmann and Cherry in 1956. It is a poorly differentiated subtype of adenosquamous carcinoma. It is characterized by glassy cells which have abundant glycogen in their cytoplasm. It typically affects young women, with peak incidence between third and fourth decades of life.[1] GCC runs an aggressive course; the disease is already at an advanced stage at the time of diagnosis. Despite a combination of radical surgery, chemotherapy, and radiotherapy, the prognosis is reserved.


  Case Report Top


A 40-year-old menopausal, multiparous female patient presented with a history of bleeding and discharge per vaginum for 1 month. She was a smoker for the past 25 years and menopausal for the last 3 years. At assessment, local examination and ultrasound examination were performed. Per speculum examination revealed a 4 cm × 4 cm fungating growth involving both the cervical lips. Upper rim of the vagina and parametrium were also involved. Ultrasonography showed a heterogeneous hypoechoic mass of size 6.2 cm × 6 cm × 5.8 cm in the cervix extending into lower uterine segment. The mass was encasing bilateral ureters causing bilateral hydronephrosis, hydroureter, and pyometra.

A biopsy was taken from the mass which revealed tissue fragment comprised nests and sheets of tumor cells surrounded by dense stromal inflammatory infiltrate, comprised lymphocytes, plasma cells, and eosinophils [Figure 1].
Figure 1: Microscopic examination showing tissue fragment comprised nests and sheets of tumor cells surrounded by dense stromal inflammatory cell infiltrate (H and E, ×100)

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The tumor cells were pleomorphic with vesicular nuclei, focally prominent nucleoli, and moderate amount of eosinophilic cytoplasm with well-defined cell boundaries [Figure 2]. Numerous mitotic figures and occasional bizarre tumor cells along with focal keratin pearl formation were seen [Figure 3]. On the basis of the histopathological examination, the diagnosis of GCC of the uterine cervix was made. The patient then received four cycles of radiotherapy till date and is on follow-up. Due to deranged liver function tests, no chemotherapy was given to the patient.
Figure 2: Microscopic examination showing highly pleomorphic tumor cells, with vesicular chromatin, focally prominent nucleoli, and moderate amount of eosinophilic cytoplasm with well-defined cytoplasm. There is dense stromal inflammatory cell infiltrate, comprised lymphocytes, plasma cells, and lymphocytes (H and E, ×400)

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Figure 3: Microscopic examination showing numerous mitotic figures, occasional bizzare tumor cells along with focal keratin pearl formation (H and E, ×400)

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  Discussion Top


The World Health Organization classifies GCC as a subtype of epithelial tumors, occurring in 1%–5% of all cervical cancers. The mean age is 10 years younger than in other histological subtypes.[2] A strong association has been found with high-risk human papillomavirus (HPV). An association has also been found with recent and current pregnancy.[3],[4],[5]

The tumor usually presents as an ulcerated or nonulcerated growth around the squamocolumnar junction. It may grow into the endocervical canal in a barrel-shaped fashion with extension into the vagina and parametrium. It can also present as a cervical polyp or as a microinvasive lesion. Despite a large tumor volume, the cervical stroma is generally involved only superficially.[6]

On histomorphology, the tumor can be missed for large cell nonkeratinizing squamous cell carcinoma, lymphoepithelioma-like carcinoma, and clear cell carcinoma (mesonephroid carcinoma) of the cervix. Abundant glycogen in the cell cytoplasm gives them their characteristic glassy appearance (cytoplasm resembles ground glass, hence the name “glassy cell”). The exact percentage required for diagnosing this lesion is not exactly known; however, anywhere from 30% to 100% of the cells with this “glassy” appearance in a tumor makes it GCC.[7] Based on the criteria established by Gluksmann and Cherry and amplified by Littman et al., there are three main criteria for microscopic diagnosis of GCC: (1) cells with moderate amount of cytoplasm and a ground glass or finely granular appearance; (2) a distinct cell cytoplasm that stains with eosin and periodic acid-Schiff; and (3) large nuclei with prominent nucleoli.[8]

It is important to differentiate it from adeno or squamous cell carcinoma as GCC has a rapid progression rate and a high rate of metastasis outside the pelvis. Local recurrence occurs to apex of vagina, parametrium, and para-aortic lymph nodes. Distant metastasis to lung, liver, spleen, and bones have been observed.[9] Some studies have shown myocardial metastasis on necropsy, thus suggesting both hematogenous and lymphatic spread of metastasis.[3] Jung et al. in their study revealed that GCC has association that high-risk HPV types 18, 16, and 31.[10] Immunohistochemically, GCC expressed markers for both squamous cell carcinoma (p63 and CK34βE12) and adenocarcinoma (CAM5.2, MUC1, MUC2, and CEA). Ki-67 proliferation index was high (≥70%). Owing to its aggressive nature and depending upon the stage of the disease, surgery, chemotherapy, and chemoradiotherapy form the treatment modalities.[11],[12]


  Conclusion Top


GCC is a poorly differentiated adenosquamous carcinoma of the cervix, hallmarked by aggressive behavior, occurrence in association with pregnancy, and a poor patient survival rate. It typically occurs in young women. They grow rapidly and may present at an advanced stage. Due to its aggressive course, early diagnosis and treatment are required, but the prognosis still remains dismal.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martins TR, Araújo LF, Marangon LM, Carvalho VJ, Sampaio RS, Monnerat AL et al. Glassy cell adenocarcinoma of the uterine cervix in young patient with HPV: Case report. J Bras Doenças Sex Transm 2010;22:2177-8264.  Back to cited text no. 1
    
2.
Lotocki RJ, Krepart GV, Paraskevas M, Vadas G, Heywood M, Fung FK, et al. Glassy cell carcinoma of the cervix: A bimodal treatment strategy. Gynecol Oncol 1992;44:254-9.  Back to cited text no. 2
    
3.
Johnston GA Jr., Azizi F, Reale F, Jones HA. Glassy cell carcinoma of the cervix: Report of three cases. J Natl Med Assoc 1982;74:361-3.  Back to cited text no. 3
    
4.
Cherry CP, Glucksmann A. Incidence, histology, and response to radiation of mixed carcinomas (adenoacanthomas) of the uterine cervix. Cancer 1956;9:971-9.  Back to cited text no. 4
    
5.
Seltzer V, Sall S, Castadot MJ, Muradian-Davidian M, Sedlis A. Glassy cell cervical carcinoma. Gynecol Oncol 1979;8:141-51.  Back to cited text no. 5
    
6.
Deshpande AH, Kotwal MN, Bobhate SK. Glassy cell carcinoma of the uterine cervix a rare histology. Report of three cases with a review of the literature. Indian J Cancer 2004;41:92-5.  Back to cited text no. 6
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7.
Hadi R, Kumar M, Pat S, Das P, Vaid A, Gupta SD et al. Glassy cell carcinoma (GCC) of uterine cervix. Sri Lanka J Obstet Gynaecol 2011;33:65-7.  Back to cited text no. 7
    
8.
Zolciak-Siwinska A, Jonska-Gmyrek J. Glassy cell carcinoma of the cervix: A literature review. Eur J Obstet Gynecol Reprod Biol 2014;179:232-5.  Back to cited text no. 8
    
9.
Litmann P, Clement P, Henriksen B, Wang CC, Robboy SJ, Taft PD, et al. Glassy cell carcinoma of cervix. Wiley Interscience J 2006;37:2238-46.  Back to cited text no. 9
    
10.
Jung YY, Nahm JH, Kim HS. Cytomorphological characteristics of glassy cell carcinoma of the uterine cervix: Histopathological correlation and human papillomavirus genotyping. Oncotarget 2016;7:74152-61.  Back to cited text no. 10
    
11.
Yoon N, Kim JY, Kim HS. Clinical outcomes of advanced-stage glassy cell carcinoma of the uterine cervix: A need for reappraisal. Oncotarget 2016;7:78448-54.  Back to cited text no. 11
    
12.
Gray HJ, Garcia R, Tamimi HK, Koh WJ, Goff BA, Greer BE, et al. Glassy cell carcinoma of the cervix revisited. Gynecol Oncol 2002;85:274-7.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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