ADENOID BASAL EPITHELIOMAS OF THE UTERINE CERVIX - A REEVALUATION OF DISTINCTIVE CERVICAL BASALOID LESIONS CURRENTLY CLASSIFIED AS ADENOID BASAL CARCINOMA AND ADENOID BASAL HYPERPLASIA

A series of 12 adenoid basal carcinomas and three adenoid basal hyperp lasias of the cervix were analyzed. The ages of the patients with aden oid basal carcinoma ranged from 30 to 91 years with a mean of 71 years . Pap smear results for 11 of 12 (92%) were abnormal. Almost all patie nts were asymptomatic. None had a gross cervical tumor. All tumors had typical histologic features of adenoid basal carcinoma, with various degrees of squamous differentiation. Depth of tumor invasion ranged fr om 2 mm to 10 mm (mean, 4.3 mm; median, 3.7 mm), exceeding 3 mm in six tumors (50%). Tumor volume was >500 mm(3) in four tumors (33%). An as sociated neoplastic squamous lesion was present in 92% of patients, in cluding high-grade cervical intraepithelial neoplasia in 10 cases and microinvasive squamous cell carcinoma in one. Treatment was predominan tly surgical, usually after some form of cervical conization; conizati on alone was performed in three patients. Lymph nodes were removed in five patients; none of 104 nodes had metastases. No recurrence of tumo r developed in any patient. Nine patients were alive without disease a fter 4 to 82 months (mean: 30 months), and three died without disease after 24, 63, and 87 months. The three patients with adenoid basal hyp erplasia also were asymptomatic and did not have a gross cervical lesi on. Pap smear results for two patients were abnormal. The adenoid basa l hyperplasias were incidental, very superficial lesions that resemble d small adenoid basal carcinomas. Generally, they were attached to the squamous or endocervical mucosal epi thelium; all were less than 0.5 mm in depth. Treatment was hysterectomy in one patient and conization in two. Follow-up was short but uneventful. Our findings, together wit h those previously reported. indicate (1) adenoid basal carcinoma with typical histologic features is not a malignant neoplasm in that it ty pically presents in asymptomatic women, usually is discovered after an abnormal Pap smear result due to cervical intraepithelial neoplasia, does not produce a grossly visible lesion: has never metastasized to r egional lymph nodes or elsewhere, and has never itself caused death; ( 2) rare, histologically atypical tumors with distinctly malignant feat ures should not be regarded as adenoid basal carcinoma; and (3) adenoi d basal hyperplasia probably is a small adenoid basal carcinoma. We pr opose the term ''adenoid basal epithelioma'' to replace adenoid basal carcinoma and adenoid basal hyperplasia, because it better describes t he clinicopathologic features of these distinctive lesions and their e xcellent prognosis and may reduce the Likelihood of unnecessarily aggr essive treatment.