Pattern A |
No destructive stromal invasion |
Well-demarcated glands with rounded contours, commonly forming groups |
No single cells or cell detachment |
Complex intraglandular growth allowed (ie, cribriform, papillae), less than a 4× field (5 mm in diameter) |
No solid growth or high-grade cytology |
No LVI |
Irrelevant relationship to large cervical vessels or depth of the tumor |
Pattern B |
Localized (limited, early) destructive stromal invasion arising from well-demarcated glands (pattern A-like glands) |
Individual, ragged glands or small clusters of tumor cells, separated from the rounded glands, usually in an inflamed or desmoplastic stroma |
Foci may be single, multiple, or linear at the base of the tumor, less than a 4× field (5 mm in diameter) |
No solid growth |
LVI (±) |
Pattern C |
Diffuse destructive invasion:
|
Confluent growth:
|
Solid:
|
Extensive linear destructive:
|
Band-like lymphocytic infiltrate:
|
Micropapillary:
|
LVI (±) |
Adapted with permission from: Roma AA, Diaz De Vivar A, et al. Invasive endocervical adenocarcinoma: A new pattern-based classification system with important clinical significance. Am J Surg Pathol 2015; 39(5):667-72. Copyright © 2015 Wolters Kluwer Health, Inc. https://journals.lww.com/ajsp/pages/default.aspx.
Updated with information from: Alvarado-Cabrero I, Parra-Herran C, Stolnicu S, et al. The Silva pattern-based classification for HPV-associated invasive endocervical adenocarcinoma and the distinction between in situ and invasive adenocarcinoma: Relevant issues and recommendations from the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S48.