Cervical implantation metastasis by endometrial adenocarcinoma

Abstract

A distinct type of cervical involvement by endometrial cancer is reported and termed cervical implantation metastasis. It is believed to result from implantation of endometrial cancer on the denuded endocervix after fractional dilatation and curettage (D & C). The histologic criteria for diagnosis are: (1) the cervical implantation metastasis must be imbedded in the endocervical epithelium or superficial stroma surrounded by an implantation site of inflammatory cells and granulation tissue (free‐floating cancer cells above the cervical mucosa are not acceptable as implantation tissue), (2) the histologic findings of the cervical implantation metastasis must be similar to those of the endometrial adenocarcinoma in the uterine corpus, (3) the cervical implantation metastasis must be separate from the primary tumor with no evidence of direct extension, and (4) the cervical implantation metastasis should be surrounded by nonneoplastic endocervical glands with no transition between the two. Of the 176 patients who underwent fractianal D & C before hysterectomy. nine (5%) were found to have cervical implantation metastasis. No patients had cervical implantation metastasis who did not undergo fractional D & C before hysterectomy. When stratified according to stage, grade, and myometrial invasion, there was no statistically significant difference in the recurrence rate between patients with or without cervical implantation metastasis. It appears that cervical implantation metastasis does not alter prognosis or require specific treatment.

Role of endocervical curettage in the preoperative staging of endometrial carcinoma

“…Furthermore, it has been suggested in some reports that involvement of the cervical stroma by extension of the tumour can occur under intact endocervical mucosa, which could explain 3 false negative samples in our study [25,26]. Moreover, due to curetting, endometrial tumour cells can be implanted in the endocervical glandular tissue called cervical implantation metastasis [27]. Another phenomenon called atypical reactive proliferation involving the endocervical surface is commonly seen in association with endometrial cancer and has the potential to be misinterpreted as endocervical involvement by tumour in the uterine specimen.…”

Statistical analysis of pathologic risk factors for intramyometrial lymphvascular space involvement in myoinvasive endometrial carcinoma

“…In contrast, downstream cervical implantation is not correlated with LVSI as it may be an artifact of preoperative curettage and does not worsen the prognosis (33) .…”

Endocervical involvement in endometrial adenocarcinoma is not prognostically significant and the pathologic assessment of the pattern of involvement is not reproducible

“…With respect to discontinuous spread, Fanning et al proposed criteria to define cervical implantation metastasis by endometrial adenocarcinoma [21]. They speculated that this process resulted from implantation of endometrial cancer on the denuded cervix after fractional curettage.…”