Clinical and Imaging Features of Gastric‐Type Endocervical Adenocarcinoma

OBJECTIVES: To analyze the clinical and imaging characteristics of gastric-type endocervical adenocarcinoma (GEA) with the aim of enhancing sonographers' awareness and early diagnostic proficiency regarding this disease. METHODS: A retrospective analysis was conducted on 9 patients with pathologically confirmed GEA treated at our institution between 2021 and 2024. The study involved a systematic evaluation of clinical manifestations along with transvaginal ultrasonography and magnetic resonance imaging (MRI) characteristics, aiming to analyze the relationship between clinical features and imaging findings in this disease. RESULTS: Clinical characteristics: Nine patients were included. The patients' ages ranged from 28 to 52 years (mean 45.7 ± 8.5). Chief complaints were isolated watery vaginal discharge (4 cases), watery discharge with pelvic pain (1 case), watery discharge with post-coital bleeding (2 cases), and lower-abdominal pain alone (2 cases). HPV screening results were negative in 8 cases, with 1 case positive for HPV type 56. Thin-prep cytology test (TCT) results were negative in 7 cases; 1 case showed atypical glandular cells (suspected cervical origin), and 1 case indicated a few high-grade squamous intraepithelial lesions (HSIL). Gynecological examination revealed cervical hypertrophy with erosion (5 cases), hypertrophy with induration (2 cases), a smooth cervix with mild erosion (1 case), and a normal-size, smooth cervix (1 case). Colposcopy and cervical biopsy indicated: adenocarcinoma (3 cases), suspicious abnormalities (2 cases), CIN I (2 cases), and chronic cervicitis (2 cases). Pre-operative tumor markers: isolated elevation of CA 19-9 (2 cases), concomitant elevation of CA 19-9 and CA 125 (4 cases), and normal values for both markers (3 cases). The duration from symptom onset to diagnosis was ≥1 year in 5 cases. IMAGING FINDINGS: All patients underwent preoperative transvaginal ultrasound examination. The findings were as follows: abnormal cervical echogenicity (3 cases), cervical cancer involving the parametrium (2 cases), a cervical polyp (1 case), a cervical cyst (1 case), and no abnormality was detected in 1 case. Eight patients subsequently underwent pelvic MRI. Among these, 5 examinations were reported as malignant cervical neoplasm, 1 as endometrial carcinoma, 1 as suspicious thickening of the endocervical mucosa, and no appreciable mass was found in 1 case. CONCLUSIONS: GEA is characterized by an occult location, low rate of early detection, aggressive behavior, and poor prognosis. Nevertheless, its clinical presentation and imaging findings remain recognizable. In patients who present with persistent, profuse, watery vaginal discharge, careful evaluation of the upper and middle segments of the endocervical canal during gynecological examination and transvaginal ultrasonography is essential to improve early detection and minimize diagnostic omission.