A case of bilateral pelvic lymph node involvement in stage 1a1 squamous cell carcinoma of cervix and a review of the literature

Abstract

Stage1a1 cervical cancer has been established to define a subset of the disease in patients who may safely be managed more conservatively and who have an excellent prognosis. Recently, however, a number of stage 1a1 cases with lymph node metastasis have been reported. Some of these cases had positive lymphovascular space invasion (LVSI), which some studies have identified as a negative prognostic factor. There is still, however, disagreement between the International Federation of Gynecology and Obstetrics (FIGO) and the Society of Gynecologic Oncologists (SGO) regarding whether LVSI may be used as a staging criterion. We report a 36-year-old patient with stage 1a1 cervical cancer who was diagnosed with multiple pelvic and parametrial lymph node metastases. Histopathology showed extensive LVSI. While stage 1a1 cases may still be managed conservatively, physicians must consider the possibility of lymph node metastasis, particularly in patients with positive LVSI, and counsel patients accordingly.

Cyclin D1, E‐cadherin and beta‐catenin expression in FIGO Stage IA cervical squamous carcinoma: diagnostic value and evidence for epithelial–mesenchymal transition

“…Finally, although the prognosis of patients with superficially invasive squamous carcinoma of the cervix is generally excellent, occasionally even patients with Stage IA1 tumours develop metastatic disease. 8,9 In recent studies that were related mainly to endocervical neoplasia we observed that the infiltrative tumour cells, particularly towards the invasive margin, exhibited reduced expression of E-cadherin and betacatenin. 10,11 It is well-recognized that these adhesion proteins form a functional complex that maintains cohesion and polarity within epithelial cell groups.…”

“…The presence of invasion, even of limited extent, also implies an alteration in tumour biology or in tumour–host interactions. Finally, although the prognosis of patients with superficially invasive squamous carcinoma of the cervix is generally excellent, occasionally even patients with Stage IA1 tumours develop metastatic disease 8,9 …”

Uterine corpus metastasis in stage IA1 squamous carcinoma of the cervix

“…More recently Yeasmin reported another stage IA1 squamous cell carcinoma with widespread bilateral pelvic lymph node metastases. (Yeasmin et al, 2009) Lee et al (2006) also reported a case of a 63 year old with < 1 mm invasion depth of disease but with supraclavicular lymph node metastasis and Kang et al (2009)reported a case of stage IA1 squamous cervical carcinoma with invasion of less than 1 mm without lymphovascular involvement but with unilateral ovarian metastasis. Young et al (1993) also reported a case of unilateral ovarian Stage IA1 squamous cell carcinoma metastasis in 1993.…”

Extraregional lymph node recurrence of stage IA1 squamous cell carcinoma of the uterine cervix after initial surgery: two case studies

“…Table 1 summarizes the clinical features of patients with lymph node recurrence reported by previous studies [2][3][4][5][6] . We performed a search of the PubMed database for SCC, stage IA1, and lymph node metastasis, excluding adenocarcinoma.…”