Glassy cell carcinoma of cervix: an analysis for 20 cases and literatures review

BACKGROUND: Glassy cell carcinoma (GCC) of the cervix is defined as a rare subtype of adeno-squamous cell carcinoma (ASC) with poor prognosis. We presented our clinical data of patients with cervical GCC and reviewed the outcomes in recent years. METHODS: From 2011.1 to 2019.7, 20 cases of cervical GCC diagnosed and treated in our institution were reviewed for clinicopathologic features, treatment strategies, and outcomes. RESULTS: (I) Twenty cases confirmed as cervical GCC were selected and represented 1.8% of all invasive cervical cancer diagnoses. The median age of all cervical GCC patients was 46 years (range from 33 to 69 years). The main clinical symptoms were abnormal vaginal bleeding and postcoital bleeding. The incidence of stage I, stage II, stage III was 75%, 20% and 5%. (II) Human papillomavirus (HPV) prevalence in cervical GCC was 44.4% (4/9). Of the HPV-positive tumors, HPV genotyping was variable. Tumors of 3 cases were found infected by HPV-18. Another tumor was infected by HPV-16 and HPV-31. Multiple infections were found in 1 case. (III) The disease-free survival (DFS) of early stage cervical GCC cases was 93%, and DFS of advanced stage cervical GCC cases was 67%. DFS of all cases was 85%. The median follow-up interval for surviving patients was 28 months. Three patients recurred, leading to an overall recurrence rate of 15% (3/20). One of 3 recurred cases was from multimodal treatment group who had one high risk factor (pelvic lymph node metastasis) and three intermediate risk factors lympho-vascular space involvement (LVSI), deep stromal invasion, and large tumor size (3.5 cm). Other 2 cases recurred were from radio-chemotherapy group. CONCLUSIONS: Cervical GCC is associated with high-risk type HPV infection, especially HPV 18. The prognosis of GCC was not poor as depicted in previous studies. Early-stage GCC patients should receive multimodal treatment which reduced recurrence rate and improved survival rate. With the limitation of small sample size, we speculated surgery might play a key role in curing GCC. Patients whose pathology features includes at least two intermediate high risk recurrence or one high risk factor should accept adjuvant treatment after complete surgical management.