Cylindroma of the cervix

Cylindroma VICTOR

TCHERTKOFF,

ALEXANDER New York,

of the cervix

SEDLIS, New

M.D. M.D.

York

described C Y L I N D R o M A s have been most frequently in the parotid gland, pharynx and nasopharynx, sinuses, oral cavity, and bronchus. An occasional case has been reported in the lacrimal g1and.l Two cases have been reported originating from the breast.?2 3 Billroth” originally designated these tumors (cylindrical bands of hyaline material surrounded by cords of epithelial cells) as “cylindromas.” Synonyms in the literature are adenomyoepithelioma,5 adenoid cystic carcinoma,F adenocystic basal cell carcinoma, and pseudoadenomatous basal cell carcinoma.” Cylindromas are tumors composed of strands and cords of small basal cells with slight eosinophilic cytoplasm, hyperchromatic nuclei, and a central amorphous eosinophilic mass of varying amounts. No such lesion has been reported in the cervix, and personal communications from two sources with large series also failed to reveal this patholdgic entity in the cervixg* lo It is our purpose to report the first case of cylindroma of the cervix in a patient who also had basal cell carcinoma of the nose. We would also urge that for the sake of uniformity the term “cylindroma” be adhered to with synonyms in parentheses. Case

Patient Department Clinic on Sept. 26, 1960, because of postmenopausal bleeding and uterine prolapse. The patient’s last menstrual period was in 1946. Three months prior to admission she started to bleed vaginally. The bleeding ranged from spotting to frank hemorrhage. The prolapse was noted for the last 6 months. Physical examination disclosed a poorly nourished, partly disoriented woman appearing older than her stated age. There was a pigmented ulcerating wartlike lesion 1 cm. above the bridge of the nose. Pelvic examination revealed marked cystorectocele, second degree uterine prolapse, and a friable, easily bleeding granulating lesion on the anterior lip of the cervix. Cytologic examination of the cervical smear showed Class IV changes consistent with malignancy. On Oct. 3, 1960, the patient was admitted to the hospital, where the cervical lesion was biopsied on the same day. The examination of the blood revealed hemoglobin 11.1 Gm., white blood count 9,200, BUN 15 mg. per cent, fasting blood sugar level 76 mg. per cent; Mazzini was nonreactive, the urine was negative for albumin and sugar, x-ray of the chest and electrocardiogram were within normal limits. Intravenous pyelogram and the retrograde pyrlography revealed normal genitourinary tract; barium enema and skeletal series were negative. Because of the unusual histologic picture of the cervical biopsy, it was decided to perform laparotomy with the view to explore for possible primary lesion. The operation was performed on Oct. 18, 1961. The uterus was found to be atrophic and there were no pelvic masses. Pelvic and periaortic nodes were not enlarged. A total hysterectomy and bilateral salpingo-oophorectomy were performed. The postoperative course was uneventful. On Oct. 31, 1961, the skin lesion from the forehead was excised. The pathology report indicated basal cell carcinoma.

report

A 63-year-old Puerto Rican woman, gravida xiv, para xii, was seen in the Gynecological OutFrom the Departments of Pathology and Obstetrics and Gvnecolo~~, New York Medical College:Metro&%tan Ho.rpital Medical Center.

749

750

Tchertkoff

and

September Am. J. Oh.

Sedlis

Fig. 1. Low-power view “adenoid cystic type.”

illustrating

superficial

squamous

A resume of the pathologic examination of the biopsy specimen and subsequent total abdominal hysterectomy follows: The original cervical biopsy consisted of 5 small fragments of whitish tissue, 0.2 to 0.4 cm. in diameter. The uterus, tubes, and ovaries were submitted in toto. The corpus was firm, smooth, and grossly normal; it measured 8 by 6.5 by 3 cm. The endometrial cavity measured 6.1 by 2.2 cm. The myometrium was uniform and pink. The external OS of the cervix was firm and whitish pink. There was extensive erosion of the anterior lip. The endocervix was clean and rugated. The adnexa were grossly normal. Microscopic views of both the original biopsy specimen and subsequent sections of the cervix were similar in appearance. The dominant areas were characterized by cords and bands of varying size and shape. These cords and bands consisted of small, darkly stained cells with relatively little cytoplasm. They were surrounded by broad bands of loose fibrous and areolar tissue. There were somr solid cords of small, dark cells, but many had varying sized central cystic areas (so-called adenoid cystic pattern). The cystic areas contained homogeneous amorphous material which stained weakly eosinophilic and was mucicarmine positive. The surface squamous epithelium was ab-

cell

carcinoma

sent over extended

intermingling

15, 1962 & Gynec.

with

the cylindromatous deeply into the

tumor. cervix.

The tumor Contiguous

areas showed typical squamous cell carcinoma composed of moderately well-differentiated squamous and horn cells which also extended into the areas of cylindromatous basal cells. (Figs. 1 and 2. ) Microscopic diagnosis was cyclindroma of cervix and squamous cell carcinoma of the cervix.

Comment ArenaP cervix,

reported but

scription ing

leave

with The

nests

of

cylindromatous of tion

a basal nose.

patient

that

had and

It

reported

was

had

carcinoma

and

neoplastic

basal

dedeal-

cell

carcinoma

can

be

tissue

of areas

cells

had bridge

that tumor

elements

a

patient

of the

postulated for

several

areas

other The

a propensity

that

the

and

he

appearance.

had the

of

pictures

adenocarcinoma.

herein cell

cylindrorna his

doubt

a typical

squamous

also

of

no

case

where

a

review

this

formadid

so

simultaneously. The open arises

histogenesis to from

question. some

of Most skin

cylindroma authors appendages.

is feel

that

still it

Cylindroma

Fig. 2. High-power dromatous patterns.

view

to illustrate

close

Sutherlandl” regards them as arising from sweat glands, Kleine-Natrop13 from hair follicles, and Balog I4 from apocrine glands, with LeverI” favoring the latter. Apocrine glands and thus apocrine tumors have with some frequency been described in the vulva. Apocrine glands do not occur in the cervix. To ascribe cylindromas of the cervix to possible misplaced apocrine glands would, because of embryologic considerations, be far-fetched. More plausible would be a metaplasia of basal layers to an adnexal cell type as postulated by Kleine-Natrop. We must admit, however, that these theories are all speculative. Confusion sions

were

would

reported

be

avoided

if

as cylindromas

these

le-

as per

association

but

separate

Billroth’s description parenthesis.

of the

squamous

cervix

cell

and

751

cylin-

and any synonyms be in

Summary

The first cylindroma of the cervix is reported. The patient also had squamous cell carcinoma of the cervix and basal cell carcinoma of the bridge of the nose. The exact histogenesis of cervical cylindromas still remains to be elucidated. It is urged that the original term, “cylindroma,” be limited to those lesions fulfilling Billroth’s criteria. We

wish

to

thank

Dr.

Angelo

M.

Sala

for

originally suggesting the diagnosis to us. Photography by Walter Doran, Photographer to Metropolitan Hospital, New York City.

REFERENCES

1. Reese, A. B.: Tumors of the Eye, New York, 1951, Paul B. Hoeber, Inc., p. 476. 2. Mayer, H. R.: Dis. Chest 31: 324, 1957. 3. Geschickter. C. F.: Disease of the Breast, ed. 2. Philadelphia, 1945, J. P. Lippincott.

4. 5. 6.

Billroth and Beobachtunger: Arch. Anat. 17: 357, 1859. Bauer, W. H., and Fox, R. A.: Arch. 39: 96, 1945. Foote, F. W., Jr., and Frazell, E. L.:

path. Path. Atlas

752

7. 8. 9. 10. 11.

Tchertkoff

and

September Am. J. Obst.

Sedlis

of Tumor Pathology, sec. 4, fast. 2, Armed Forces Institute of Pathologv. 1954. Stein, I., and Geschickter, C. F.: Arch. Surg. 28: 492, 1934. Smout, M. S., and Franch, A. J.: A. M. A. Arch. Path. 72: 107, 1961. Stout, A. P.: Personal communication. Fuller, R. H., Armed Forces Institute of Pathology: Personal communication. Arenas, N., and Davison, T.: Obst. y ginec. latino-am. 7: 415, 1959.

12. 13. 14. 15.

15, M’2 & Gynec.

Sutherland, T.: J. Path. & Bact. 72: 663, 1956. Kleine-Natrop, H. E.: Arch. klin. u. rxper. Dermat. 209: 45, 1959. Balog, P.: Dermat. Wchnschr. 82: 891, 1926. Lever, W. F.: Histopathology of the Skin, ed. 3, Philadelphia, 1961, J. B. Lippincott Co., p. 460. 1801 New

First York

Aue. 29, New

York