The last is the well-differentiated villoglandular adenocarcinomas. These adenocarcinomas have a very good prognosis and they usually occur in younger women. Most of these adenocarcinomas occur in about the 50s. The well-differentiated adenocarcinoma usually occurs in a woman at the median age of about 37. They have a very good prognosis.
The next case is a lady in her 50s who also presents with vaginal bleeding. On physical examination, the gynecologist noted a mass in the cervix. A biopsy was performed, revealing squamous cell carcinoma and hysterectomy was therefore performed. On examination of the uterus, on higher power, one can see that the cervix is entirely replaced by a polypoid, irregular mass. On closer exam, one can see infiltrating nests of tumor cells. The tumor is composed of these anastomosing cords and tongues of neoplastic squamous epithelium. The stroma is very reactive.
The overlying squamous epithelium shows severe dysplasia or carcinoma in situ. The invasiveness of this tumor is clearly seen in the very irregular, shaggy and tongue-like contours. The stromal reaction is pronounced as well with inflammatory cells and a more desmoplastic, spindly-type reaction. This is the reaction the stroma has when there is an invasive tumor. On higher power, one can see that the neoplastic epithelium consists of very pleomorphic cells, some of them multinucleated with numerous mitoses and some evidence of individual cell keratinization. A keratin pearl is when keratin is deposited in a concentric whirl in the center of neoplastic squamous epithelium. This is evidence that this is a squamous differentiation, because it has a keratin pearl.
The WHO have classified squamous cell carcinomas as to whether they are keratinizing or non-keratinizing. The keratinizing tumors have these keratin pearls; the non-keratinizing do not. As to prognostic significance, there are essentially very conflicting studies as to whether this really has any prognostic significance.
Intercellular bridges are also evidence of squamous differentiation.