Early Invasive Adenocarcinoma of the Uterine Cervix

Abstract

In an attempt to determine the natural history of early invasive adenocarcinoma of the cervix, defined as depth of invasion of 5 mm or less, an extensive review of the literature was undertaken, together with recent unpublished material of the author. Many of the cases had to be extracted from series dealing with microinvasive squamous cell carcinoma. The pons asinorum for the pathologist is the differentiation between adenocarcinoma in situ and early invasion. The criteria for microinvasion are: 1.) obvious invasion to 5 mm or less; 2.) usually complete obliteration of the normal endocervical crypts; 3.) extension beyond the normal glandular field; and 4.) a stromal response characteristic of invasive carcinoma. Not all of these criteria are present in every case. In all 436 cases were collected. Allowing for vagueness of reports, 126 patients were treated by radical hysterectomy, and none had parametrial involvement. No cases of adnexal tumors were found in the 155 patients in whom one or both ovaries were removed. Of the 219 patients with pelvic lymph node dissection, five (2%) had metastasis. There were 15 recurrences and six tumor-related deaths in the 436 patients. Only 21 patients had conization as the only treatment, and none has suffered a recurrence. It appears that early invasive adenocarcinoma behaves in the same way as its squamous counterpart. Cold knife conization is acceptable treatment only when the cone biopsy has been adequately sampled and the margins are free, especially when preservation of fertility is an issue. Loop excision procedures obscure depth of invasion and margins and are not acceptable either for diagnosis or therapy. Multicentricity does not appear to require cylindrical cones. If hysterectomy is contemplated, removal of the adnexa, per se, is unnecessary.

New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome

“…A small minority of pattern A tumors may be interpreted by some pathologists as endocervical adenocarcinoma in situ (AIS); however, many of the cases in this study classified as pattern A had large grossly visible and deep tumors that could not have been considered as in situ lesions. While studies indicate that a clear distinction of invasive EAC from adenocarcinoma in situ is not possible in up to 20% of cases [29–30], this new system makes that distinction in difficult cases irrelevant as nodal dissection is unnecessary in both AIS and pattern A tumors, as patients would have an excellent prognosis.…”

Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

“…Another concern may be the difficulty to exactly stage the microinvasive glandular lesions. The lesion is measured from the point of origin in the basal membrane of the epithelium or crypt, but the invasion is not easy to identify, and at this point it may be impossible to determine, even for experienced pathologists [1]. Invasion is more readily identified beyond the normal glandular field; a stromal response of oedema, loose fibrosis, and inflammation often accompany invasion.…”

“…MIAC corresponds to FIGO stages Ia1 and Ia2, and its frequency, compared to all microinvasive cervical cancers (MICC), is about 12% [1]. The large presence of cytological-based screening programs in developed countries led to an increasing number of diagnoses in younger women [2], often in childbearing age.…”

Proceedings From the First Asia‐Oceania Research Organisation on Genital Infections and Neoplasia (AOGIN) Meeting

“…Östör and Rome reported outcomes for 436 women with microinvasive adenocarcinoma defined as invasion ≤ 5 mm, and associated with complete obliteration of normal endocervical crypts, extension beyond normal glandular fields, and stromal response [141]. Of these women, 126 underwent radical hysterectomy, not necessarily with simultaneous removal of adnexa.…”