Clinical and sonographic characteristics of gastric-type endocervical adenocarcinoma: a descriptive case series of 13 patients

Objective Gastric-type endocervical adenocarcinoma (G-EAC) is a distinct human papillomavirus (HPV)-independent subtype of cervical adenocarcinoma for which early diagnosis continues to pose a clinical challenge. We set out to characterize the clinical and sonographic features of G-EAC and to provide hypothesis-generating observations to guide future research. Methods This retrospective analysis comprised 13 patients with histopathologically confirmed G-EAC who underwent surgery at our center between August 2017 and September 2024. We reviewed and descriptively summarized the clinical presentation, HPV and cytology results, cervical biopsy findings, tumor markers, and ultrasonographic and cross-sectional imaging findings, together with all available pathological and surgical records. Results The patients were aged 39–76 years (mean, 53.4 years), and all were parous. Vaginal discharge was the most common presenting symptom (8/13, 61.5%), followed by irregular vaginal bleeding (4/13, 30.8%) and postcoital bleeding (1/13, 7.7%). HPV testing was negative in 11/13 patients (84.6%); 1/13 (7.7%) tested positive for HPV 58, and another 1/13 (7.7%) carried a different high-risk HPV type. ThinPrep cytologic testing (TCT) was negative in 12/13 patients (92.3%), whereas atypical squamous cells were detected in 1/13 (7.7%). Among the 11 patients who underwent colposcopy with cervical biopsy, histopathological findings were negative in 8/11 (72.7%), mild glandular atypia was identified in 2/11 (18.2%), and rare adenocarcinoma cells were identified in 1/11 (9.1%). All 13 patients underwent preoperative ultrasound. Ultrasound findings raised suspicion of cervical malignancy in 9/13 patients (69.2%), were suggestive of benign cervical cystic lesions in 2/13 (15.4%), and were unremarkable in the remaining 2/13 (15.4%). A honeycomb sonographic pattern was present in 7/13 patients (53.8%), and abundant intralesional vascularity (Adler grade III) was present in 9/13 patients (69.2%). Preoperative MRI was performed in 10/13 patients (76.9%), 1 of whom also underwent CT, whereas the remaining 3/13 patients (23.1%) underwent neither MRI nor CT. A barrel-shaped cervix was documented in the pathological or surgical records of 4/13 patients (30.8%). Conclusion G-EAC may come to attention through a combination of clinical and imaging findings that together raise diagnostic suspicion. In this series, HPV negativity was common, and vaginal discharge was the most frequent presenting complaint. A honeycomb sonographic pattern and abundant intralesional vascularity may raise suspicion of G-EAC, although these findings remain descriptive and require validation in larger, adequately controlled studies.