ObjectiveTo compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.MethodsWe selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.ResultsAbout twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.ConclusionThirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Primary signet ring cell carcinoma of the cervix is extremely rare. A 47-year-old woman visited for postcoital vaginal bleeding during the last six months. Gynecologic examination revealed mild cervical erosion and touch bleeding. Colposcopic punch biopsy revealed a signet ring cell type of mucinous adenocarcinoma. The patient underwent radical hysterectomy with bilateral salpingooophorectomy, pelvic lymph node dissection, and para-aortic lymph node dissection. Microscopically, the tumor mainly consisted of two different types of cells; mixed signet ring cell carcinoma (70%) and mucinous carcinoma of intestinal type (30%). The patient died in 6 months after operation. The prognosis of primary signet ring cell adenocarcinoma of the uterine cervix is still unclear because of the extremely rare incidence of cases. In this case, we could suggest that this type of carcinoma has an aggressive behavior.Keywords: Signet ring cell carcinoma, Uterine cervical neoplasm, Adenocarcinoma Copyright © 2011. Korean Society of Obstetrics and GynecologyCarcinoma of the uterine cervix is the most common malignancy in female genital tract, and squamous cell carcinoma is the commonest of them. Adenocarcinomas of the uterine cervix have increased in both relative and absolute frequency. The current frequency of cervical adenocarcinoma is 15-20% of all cervical carcinomas and most of them are endocervical type [1]. Adenocarcinomas with signet ring cell are mostly metastatic from gastric, breast, colonic or ovarian carcinomas and primary tumor is extremely rare [2][3][4]. We describe an unusual case of woman with having primary signet ring cell carcinoma of the uterine cervix. Case ReportA 47-year-old woman, gravida 5, para 4, visited her gynecologist for postcoital vaginal bleeding during the last six months. She denied ever taking oral contraceptives and never complained of gastrointestinal symptoms. Gynecologic examination revealed mild cervical erosion and touch bleeding. The physician decided to perform a cervical cytologic examination and endocervical curettage. Histopathologic examination of the former showed poorly differentiated carcinoma of undetermined type and the latter showed small cell carcinoma. Colposcopic punch biopsy was done and the result was a signet ring cell type of mucinous adenocarcinoma.The results of laboratory studies including analysis of tumor markers were all within normal limits (squamous cell carcinoma related antigen 0.8 ng/mL, CA-125 17.3 U/mL, carcinoembryonic antigen [CEA] 1.0 ng/mL). Human papilloma virus (HPV) type 18 and 16 were negative. We tried to find an extragenital primary tumor. Abdominopelvic magnetic resonance imaging (MRI) demonstrated about 5×10 mm size mass in the endocervical canal and did not demonstrate any possibility of metastatic tumor or tumor derived from other origins. Whole body positron emission tomography showed only increased fl urodeoxyglucose uptake along the deep portion of endocervical canal suggesting malignant tissue but no other abnormal fi nding. Korean J Obstet ...

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