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PubMedDate not supplied

[Intraepithelial cervical lesions: colpo-microcolposcopic diagnosis].

Integration of colposcopy and microcolposcopy allows to perform a complete study of eso- endo-cervix, for a diagnostic and topographic evaluation of cervical intraepithelial lesion. We have endoscopically studied 172 patients with histologically demonstrated CIN. In 218 cases (74.4%) the microcolposcopical evaluation corresponded to the histological diagnosis. These data confirm the methodological effectiveness of microcolposcopy and recommend it as helpful mean for cervical pathology investigation. However we believe that histological evaluation is necessary for a correct staging of the lesion. According to our experience indications for microcolposcopy are: 1) identification of endocervical lesion and squamo-columnar junction, when colposcopically not evident; 2) possibility of performing a "tailored" conization; 3) study of endocervix after conization.

Biopsy↗
PubMed1996

Colposcopy monitoring in pregnancy complicated by CIN and early cervical cancer.

The aim of the study was the evaluation of the role of colposcopy in the diagnosis, monitoring and treatment qualification of CIN and early cervical cancer in pregnancy. Thirty pregnant women with these lesions aged 25-39 years were diagnosed and observed with the use of colposcopy as the first diagnostic step supplemented by cytology and directed biopsy. In 26 cases of CIN and 2 cases of microcarcinoma, conization was performed at the earliest 6 weeks after delivery. Three groups of lesions were distinguished: 1) progressive, including 2 (6.6%) cases of CIN progressing to microcarcinoma; 2) regressive, including 6 (20%) cases of CIN3a, and 3) stationary, including 20 (66%) cases of CIN1-3 and 2 cases of microinvasion. The majority of women were followed up for 7-35 weeks, including the course of pregnancy and 6 weeks prior to treatment. The follow-up after treatment was determined firstly every 3, then 6 and finally every 12 months. Concluding, colposcopy with directed biopsy and complementary cytology can be regarded as the best management strategy in the diagnosis of CIN and early cervical cancer in pregnancy, as well as in monitoring and treatment qualification of these patients after vaginal delivery. CIN of all grades, and some cases of early invasion which do not have progressive tendencies can be treated 6 weeks after delivery, chiefly by means of diagnostic-therapeutic conization.

Adult↗
PubMed1996

Cervical and vaginal cytologic smears suggestive of adenocarcinoma.

OBJECTIVE: To determine the appropriate evaluation of women with cervical cytologic smears suggestive of adenocareinoma. STUDY DESIGN: Of 1,192,972 smears obtained between July 1989 and March 1992, 57 (0.005%) were interpreted as adenocarcinoma, adenocarcinoma in situ or "rule out" adenocarcinoma. Review of medical records allowed the determination of pathologic diagnoses in 46 of 57 women. Thirty of the 46 cytologic smears were reviewed. RESULTS: Fifteen of the 46 women were premenopausal and < 50 years of age. Twenty-three were asymptomatic, 22 had abnormal vaginal bleeding, and 1 had increasing abdominal girth. Twenty-nine (63%) of the 46 women had cancer, 12 (26%) had cervical intraepithelial neoplasia 2 (CIN 2) or 3, and 5 (11%) had CIN 1, condyloma or no pathology. Of the 29 women with cancer, 11 had cervical cancer, 1 had vaginal cancer, 13 had uterine cancer, and 4 had extrauterine cancer. Nineteen of 22 women (86%) with abnormal vaginal bleeding had cancer; 9 of 23 asymptomatic women had cancer (39%) (chi 2 = 9.84, P < .01). DISCUSSION: Women with smears suggestive of adenocarcinoma require biopsy of cervical or vaginal masses, colposcopy with directed biopsy, endocervical curettage and endometrial biopsy. If cancer is not diagnosed, cervical conization with dilatation and curettage (D&C) is indicated. If conization with D&C is negative, laparoscopy is indicated to exclude extrauterine cancer.

Adenocarcinoma↗
PubMed1976

Experience with 40,000 Papanicolaou smears.

Forty thousand consecutive cytologic smears and subsequent diagnostic procedures resulted in the diagnosis of 41 carcinomas in situ, 35 microinvasive and invasive carcinomas, and 24 severe dysplasias for a yield of significant neoplasia of one lesion per 400 Papanicolaou smears. Twenty-five of the carcinomas in situ and microinvasive and invasive carcinomas were diagnosed in patients with atypical smears indicating that all patients with persistent atypical smears require evaluation by tissue examination. Seventy-eight percent of the 119 patients subjected to conization either had carcinoma in situ, microinvasive and invasive carcinoma, or significant cervical dysplasia. Post-operative complications following conization were negligible. In addition there were no postconization deleterious effects on three concurrent and nine subsequent pregnancies. A history of gonorrhea places a patient at a higher risk of developing cervical carcinoma. Annual performance of cytologic smear evaluation is indicated in all sexually active women and in all virginal women over 20 years of age.

Adenocarcinoma↗
PubMed1976

Lymph node metastasis in microinvasive epidermoid cancer of the cervix.

A retrospective series of 69 patients indicates that the definition of a diagnosis of microinvasive cancer of the cervix should indicate a lack of blood vessel or lymphatic permeation as well as invasion of not more than 3 mm below the basement membrane. The incidence of lymph node metastases in this group of patients in whom microinvasive cancer of the cervix had been diagnosed was 7.1%. Two of the 4 patients with positive lymph nodes demonstrated lymphatic or blood vessel permeation on preoperative conization and 2 did not, an incidence of 3.6%. One patient had lymphatic invasion on conization with negative lymph nodes on final surgical specimen. Two patients had recurrent epidermoid carcinoma within less than 10 years and died of recurrent carcinoma. Maximum survival can only be achieved by full treatment of Stage IA lesions. Since surgical mortality was absent in our series, surgical extirpation by extensive (radical) hysterectomy and bilateral lymphadenectomy should give optimum results.

Biopsy↗
PubMed1976

Long-term followup of 1121 cases of carcinoma in situ.

A series of 1121 patients with carcinoma in situ have been followed for 5 to 25 years. Recurrences of in situ lesions and development of invasive cancer wwere found, often many years after treatment. Thereapeutic conization was performed in 795 patients, of which 19 (2.3%) had recurrent carcinoma in situ and 7 patients (0.9%) developed invasive cancer. The corresponding figures for 238 patients treated with hysterectomy were, respectively, 3 (1.2%) and 5 (2.1%). The invasive lesions appeared after treatment several years later than the in situ lesions. It is stressed that women having once had in situ carcinoma of the cervix will always be at some risk, and therefore should be carefully followed for a much longer time than the conventional 5 years. Of 42 cases of preinvasive carcinoma extending to the border of the surgical specimen in which conization was performed, 25 were not immediately treated but only observed. Four of these patients developed recurrence from 2 to 6 years after treatment, while 21 are well after a followup period of between 5 and 15 years.

Adult↗
PubMed1997

[Diagnosis and therapy of cervical intraepithelial dysplasia in Austria: a survey].

PURPOSE: To assess the present state of diagnosis, therapy and follow-up of cervical intraepithelial neoplasia (CIN) in Austria. MATERIAL AND METHODS: 100 questionnaires were sent to all departments of Gynecology and Obstetrics in Austria. The anonymous questionnaire consisted of 22 multiple choice questions. It was possible to choose one or more answers by ticking applicable boxes, with the option in individual cases of giving additional information in the form of free text. RESULTS: 55 (55%) departments returned their answered questionnaires, indicating growing consciousness of quality control in medicine. It was found that in the collection of cytologic specimens 67% of the departments used a wooden spatula and cotton swabs. Management of patients with Pap smears indicating low grade squamous intraepithelial lesion (LSIL) and abnormal colposcopy, in 36 (65%) departments consisted of punch biopsy for histological diagnosis. After 3 recurrent Pap smears indicating LSIL, 76% of the hospitals treated such patients by conization, regardless of the histological grade of the lesion. Following inadequate resection of CIN III by conization, operative management of patients was the most commonly used regimen. CONCLUSION: We regard the results of this survey as a basis for the development of further quality management strategies in the prevention, diagnosis and therapy of cervical intraepithelial neoplasia in Austria.

Austria↗
PubMed1998

Pharmacokinetics and selectivity of aminolevulinic acid-induced porphyrin synthesis in patients with cervical intra-epithelial neoplasia.

Photodynamic therapy (PDT), due to its tumor selectivity, represents an alternative approach to diagnose and treat cervical intra-epithelial neoplasia (CIN) without altering normal surrounding tissue. Our aim was to investigate the pharmacokinetics and the selectivity of 5-aminolevulinic acid (5-ALA)-induced porphyrin fluorescence after topical administration, to obtain basic clinical data for future diagnostic fluorescence imaging and PDT protocols for CIN. Twenty-eight non-pregnant women with a cytological diagnosis of low-grade or high-grade squamous intra-epithelial lesions were included. An aqueous solution containing 3% 5-ALA was topically applied 1 to 6 hrs prior to conization using a cervical cap. After excision, porphyrin-induced fluorescence was quantified in dysplastic (n = 14) and normal epithelium (n = 28) by means of quantitative fluorescence microscopy. High values of porphyrin fluorescence were found in squamous epithelium between 150 and 450 min, with a maximum at 300 min following administration of 5-ALA. Ratios of porphyrin fluorescence of dysplastic vs. surrounding normal epithelium were 1.3 and 1.21 for CIN 1 (n = 3) and CIN 2 (n = 3), respectively. In CIN 3 patients (n = 8), this ratio was 2.35; the best selectivity of 5-ALA-induced porphyrin fluorescence in CIN 3 lesions (ratio 3) was observed with a topical administration time of between 150 and 250 min. Our results demonstrate that patients with CIN 3 show higher 5-ALA-induced fluorescence compared with normal epithelium. The optimal administration time of topically applied 5-ALA was between 3 and 4 hr. Our data suggest that topical ALA-PDT and photodynamic diagnosis might be suitable for detecting CIN.

Adult↗
PubMed1999

Cervical/vaginal endometriosis with atypia: A cytohistopathologic study.

Neoplastic or atypical glandular epithelial cells of uncertain significance were reported in the preoperative smears from 10 women with cervical or vaginal endometriosis. Subsequent conization and vaginal biopsy revealed endometriotic tissue with variable epithelial atypia, but no evidence of in situ or invasive carcinoma. Review of the smears revealed appearances similar to those seen in "high cervical sampling" or in smears from patients with tubal metaplasia. The presence of large cohesive cell sheets with retained cell polarity and well-defined cytoplasmic edges, of endometrial cell "whorls" and tubular structures, and of endometrial-like stromal cells coupled with the absence of three-dimensional cell clusters, peripheral cell-sheet crowding, "cell feathering," and pseudostratified cell strips are features helpful in the distinction between cervical/vaginal endometriosis and adenocarcinoma. Diagn. Cytopathol. 1999;21:188-193.

Adult↗
PubMed1997

Correlating cone biopsy histology with operative indications.

OBJECTIVE: To correlate operative indications for and histologic findings of cold knife cone biopsy since introduction of the Bethesda system for classification of cervical cytology. METHODS: Patients undergoing cold knife conization of the cervix at adjacent urban medical centers were identified from operating logs. Data on indication and outcome were tabulated retrospectively for 294 women. RESULTS: Cone biopsy indications were sometimes multiple and included dysplastic or malignant endocervical curettage (ECC) in 66%, inadequate colposcopy in 48%, cytologic:histologic discrepancy in 16%, and suspicion of invasive cancer on biopsy in 1% of cone biopsies. For 8% of patients, none of these indications were found. The respective proportions of women with benign findings or atypical, low-grade dysplasia, high-grade dysplasia, or cancer was 16, 15, 65, and 3% for positive ECC, 26, 16, 54, and 4% for inadequate colposcopy, 22, 17, 59, and 0% for discrepancy, and 0, 0, 100, and 0% for suspicion of cancer on cytology. Outcomes were significantly worse among women with positive ECC (OR = 2.1, P = 0.006). CONCLUSIONS: The likelihood of identifying high-grade lesions in cone biopsy specimens is high, especially among women with a positive ECC, but the risk of cancer is low.

Adolescent↗
PubMed2003

Adenocarcinoma in situ coexisting with carcinoma in situ of the cervix during pregnancy.

CASE REPORT: We report a pregnant patient with adenocarcinoma in situ (AIS) coexisting with carcinoma in situ (CIS) of the cervix diagnosed by conization at 16 weeks' gestation. Apoptotic activity was higher in the CIS lesion than in the AIS lesion in the cone biopsy specimen. Postpartum evaluation confirmed the disappearance of CIS lesion with positive cone margins, however, multifocal AIS with negative cone margins was found. CONCLUSION: Clinical course and biological features of AIS associated with pregnancy may be different from those of CIS.

Adenocarcinoma↗
PubMed2005

Management of cervical adenocarcinoma in situ during pregnancy.

OBJECTIVE: Adenocarcinoma in situ (AIS) is a precursor of invasive disease that is being more frequently diagnosed during the reproductive years. Few reports have described the treatment of this condition in gravid women. The purpose of this study was to review our collective experience managing cervical AIS during pregnancy. STUDY DESIGN: Retrospective medical record review of all women diagnosed with AIS during pregnancy from 1995 to 2004 at 3 academic institutions. RESULTS: Eleven women with a median age of 32 years were identified. Five who received a diagnosis in the early second trimester underwent uncomplicated cold knife conization (CKC) at 14 to 19 weeks' gestation. Six patients underwent postpartum CKC. All 11 women delivered at term. One patient undergoing postpartum CKC required radical hysterectomy for stage IB1 cervical adenocarcinoma. Four subsequent pregnancies occurred among patients having fertility-sparing surgery. CONCLUSION: Management of cervical AIS during pregnancy by early second trimester CKC is safe for mother and fetus.

Adenocarcinoma↗
PubMed2005

Invasive cervical adenocarcinoma immediately following a cone biopsy for adenocarcinoma in situ with negative margins.

BACKGROUND: Cervical adenocarcinoma in situ is often diagnosed in younger women who may wish to preserve the potential for fertility. Given that the rate of recurrent adenocarcinoma in situ is relatively low and the risk of invasive adenocarcinoma is extremely rare, conservative management in this population after a cone biopsy demonstrates negative margins has been accepted as an appropriate management strategy. This case challenges the concept of conservative management of cervical adenocarcinoma in situ. CASE: A 42-year-old G2P2002 with previously normal annual cervical cytology had a Pap smear demonstrating atypical glandular cells of uncertain significance. A 1.5-cm lesion was noted at the endocervix, and a punch biopsy revealed adenocarcinoma in situ. A large cold knife cone biopsy confirmed cervical adenocarcinoma in situ with negative margins. Definitive therapy for in situ disease with an extrafascial hysterectomy was performed 12 days after conization, and demonstrated stage IB1 cervical adenocarcinoma. A radical parametrectomy, radical upper vaginectomy, and pelvic lymphadenectomy were without persistent disease. CONCLUSION: Conservative management of cervical adenocarcinoma in situ after a cone biopsy with negative margins does not exclude the possibility of concurrent invasive cervical adenocarcinoma. This case challenges the current balance between risk and benefit associated with the conservative management of cervical adenocarcinoma in situ.

Adenocarcinoma↗
PubMed2005

Successful term delivery following conservative management for villoglandular papillary adenocarcinoma of the uterine cervix: A case report.

BACKGROUND: Villoglandular papillary adenocarcinoma (VPA) is a rare subtype of adenocarcinoma of the uterine cervix. A conservative surgical approach is considered feasible. Only three cases of VPA and pregnancy have been reported. CASE: A 34-year-old asymptomatic woman was diagnosed of a well-differentiated VPA without extracervical spread of the disease. A cold knife conization was performed. Five years later, the patient became pregnant. The pregnancy developed without complications and was finished with a caesarean delivery, due to nonreassuring fetal status. A healthy child was born. Last control 8 years later showed no evidence of disease. CONCLUSIONS: A successful pregnancy can be completed in patients with VPA without lymph-vascular invasion treated in a conservative way. This management is particularly desirable in young women to preserve reproductive capability.

Adult↗
PubMed1998

Early invasive carcinoma of the cervix (3 to 5 mm invasion): risk factors and prognosis. A Gynecologic Oncology Group study.

OBJECTIVE: Our purpose was to evaluate the risk factors and prognosis in patients with stage IA squamous cell carcinoma of the cervix and 3 to 5 mm of invasion. STUDY DESIGN: From 1981 to 1984 the Gynecologic Oncology Group conducted a prospective clinicopathologic study of patients with stage I carcinoma of the cervix. A selective study group that was previously defined and reported included patients with squamous cell carcinoma of the cervix who were treated with radical hysterectomy and pelvic lymphadenectomy and who had disease confined to the uterus, with or without microscopically positive lymph nodes. RESULTS: One hundred eighty-eight patients had invasion of 3, 4, or 5 mm as determined by central pathology review. Patients who satisfied the 3 to 5 mm invasion definition of the current stage IA2 classification of the International Federation of Gynecology and Obstetrics (1995) are the subject of this report. CONCLUSIONS: Patients with stage IA2 carcinoma of the cervix who have 3 to 5 mm of invasion present on conization with no invasion in the hysterectomy specimen are at very low risk for lymph node metastases, recurrences, or death caused by cancer.

Carcinoma, Squamous Cell↗
PubMed1999

Spontaneous resolution rate of grade 1 cervical intraepithelial neoplasia in a private practice population.

OBJECTIVE: The purpose of this study was to assess the rate of spontaneous resolution of grade 1 cervical intraepithelial neoplasia in a private practice patient population. STUDY DESIGN: One hundred consecutive women with biopsy-proven grade 1 cervical intraepithelial neoplasia were offered expectant management in the form of repeat Papanicolaou smears every 3 months up to 1 year or treatment. Women with inadequate colposcopic examination, positive endocervical sampling, or discordant Papanicolaou smears were excluded. RESULTS: Eighty-nine (89%) women agreed to undergo expectant management. Of these, 67 (75.3%) experienced spontaneous resolution of lesions on the basis of 2 subsequent and consecutive normal smears corroborated by colposcopy. The median time to resolution was 9 months (n = 38). Seventeen (19.9%) women were treated at 1 year for persistent atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions by loop electrosurgical conization. Of these, 1 (1.1%) had a more advanced lesion (grade 2 cervical intraepithelial neoplasia). Four (4.5%) had progression before 1 year and were treated. Only 1 (1.1%) patient was lost to follow-up. CONCLUSION: Expectant management of grade 1 cervical intraepithelial neoplasia is safe and cost-effective in a reliable patient population.

Adult↗
PubMed1999

Uterine histopathologic changes after Cu-Fix intrauterine device insertion.

A study of uterine histopathologic changes after the insertion of the Cu-Fix intrauterine device (IUD) was carried out at the Obstetrics and Gynecology Department, Faculty of Medicine, Chulalongkorn University. Ten patients, who had cold conization for a suspicious Papanicolaou smear, were fitted with the Cu-Fix IUD. All patients were diagnosed as having carcinoma-in-situ of the cervix and were scheduled for hysterectomy at 6 weeks postconization. Preoperative ultrasonography showed the IUD anchoring at the uterine fundus, which corresponded with posthysterectomized findings. At the anchoring site of the nylon knot, which serves as a small retention body in the fundus, slight mononuclear cells infiltration in the myometrium was found in only one patient. However, in the endometrium, there was infiltration of mononuclear cells as well as a few plasma cells during the proliferative phase of the cycle. Evidence of local foreign body reaction was found in all patients. No patient had symptoms or signs of pelvic infection.

Conization↗
PubMed1996

Laser miniconization procedure.

OBJECTIVE: To describe the outpatient procedure of minimal conization with free-hand guided high power density carbon dioxide laser for simultaneous diagnosis and treatment of CIN producing a one-piece tissue specimen for histological examination. MATERIAL AND METHODS: 3100 non-pregnant patients with mild, moderate or severe dysplasia in pap smear, having colposcopically proved ectocervical lesions but without evidence of invasive carcinoma, or 85 pregnant patients with severe dysplasia in pap smear having extensive colposcopic signs of at least carcinoma in situ were admitted for this treatment. This outpatient procedure including cervical curettage is performed under local anesthesia to excise a one-piece 5 mm (during pregnancy 7 mm) deep minicone. RESULTS: The degree of patient discomfort, bleeding complications, postoperative pain, infection or vaginal discharge were all minimal. The procedure was fast, causing minimal thermal damage of resection lines of the minicone specimen. Histopathological examination of the non-pregnant minicones revealed microinvasive or invasive carcinoma in 1.2%, the primary cure rate was 96.1%. During pregnancy, 13.3% malignancy was found. No unexpected sudden onset of invasive carcinoma was recorded during the 15-year follow-up and the cumulative risk of recurrence for all forms of CIN was 3.02% CONCLUSIONS: The outpatient miniconization procedure, performed with a free-hand guided 60-W high power density CO2 laser is a reliable method for simultaneous diagnosis and treatment of CIN. Because of the paucity of complications, this procedure may also be appropriate during pregnancy.

Ambulatory Surgical Procedures↗