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PubMed2006

Successful delivery after vaginal radical trachelectomy for invasive uterine cervical cancer.

A 32-year-old Japanese woman was diagnosed as having stage Ib1 adenocarcinoma by diagnostic laser conization at a local hospital. She was admitted to our hospital for fertility-sparing treatment. A radical trachelectomy (RT) was performed using the laparoscopic vaginal procedure. The procedure was started with a laparoscopic pelvic lymphadenectomy. As the lymph nodes were tumor free, RT was carried out transvaginally. The excised uterine cervix and lymph nodes were pathologically negative for cancer. Eight months after the operation, the patient became pregnant without any artificial reproduction techniques. At 17 weeks of gestation, she was admitted to our hospital again for a threatened abortion. Continuous tocolytic treatment with ritodrine and daily administration of a granulocyte elastase inhibitor vaginal suppository were given. At 32 weeks of gestation, she underwent emergency cesarean section because of sudden premature rupture of the membranes. A girl weighing 1991 g was delivered, with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Both the mother and the baby were discharged without trouble. This is the first successful case in Japan of delivery after vaginal RT for invasive uterine cervical cancer.

Adult↗
PubMed1976

Carcinoembryonic antigen in intraepithelial neoplasia of the uterine cervix.

Carcinoembryonic antigen (CEA) was elevated (greater than 2.5 ng. per milliliter) in 29 of 100 patients with cervical intraepithelial neoplasia (CIN). CEA concentration was related to the amount of intraepithelial neoplasia and to the presence of glandular extension. Lymphoplasmacytic infiltration of tumor cells was unrelated to CEA levels. CEA values returned to normal within 8 weeks following surgery in 77 per cent of patients. A persistently elevated (greater than 5.0 ng. milliter) plasma CEA value following conization was associated with residual CIN in the cervix. These results suggest that sequential CEA determinations may be of value in the follow-up of those cervical cancer patients who initially have high plasma antigen levels.

Adult↗
PubMed1978

Role of endocervical curettage in colposcopy.

A series of 1,850 patients with atypical Papanicolaou smears referred to the Colposcopy Clinic at Cook County Hospital were evaluated. There were 2,000 colposcopic examinations with or without directed biopsy and 495 endocervical curettements. Records of 126 patients who had definitive diagnoses were reviewed. Of 126 patients, 41 had diagnostic conization following colposcopy-directed biopsy and endocervical curettage; 85 had only colposcopy-directed biopsy and endocervical curettage. There were two instances in which an invasive cancer was missed prior to therapy, one in the group of 41 patients (incidence of 2.4 per cent), the other in the group of 85 patients (incidence of 1.1 per cent). Cone biopsy contributed very little to establishing the diagnosis of invasive cancer following colposcopy-directed biopsy and endocervical curettage. Safety measures for endocervical curettage performed during pregnancy are presented. The management of patients evaluated by colposcopy-directed biopsy and endocervical curettement requires careful correlation of histo- and cytopathology.

Biopsy↗
PubMed1981

The effect of condom use on squamous cell cervical intraepithelial neoplasia.

Between January 1, 1968, and July 1, 1980, 377 of a total 412 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) were seen in the private office of the authors and followed for more than 6 months after biopsy and the start of treatment. Thirty-five patients were lost to follow-up. Ninety-one were treated primarily by hysterectomy. The 286 patients in whom childbearing function was to be preserved were instructed, as soon as the diagnosis of CIN was confirmed, to use a mechanical barrier (the condom) throughout intercourse. In addition to the use of the condom, 40 of the 286 underwent surgical conization and 107 underwent cryosurgery. All of these 147 patients eventually showed cytologic and colposcopic regression of the disease. One hundred and thirty-nine patients were treated with the condom alone. One hundred and thirty-six of the 139 showed complete regression of the disease. Eighteen (6.2%) of the 286 patients had late recurrences of the disease; 12 of these experienced regression again with the resumption of the use of the condom. No patients showed progression of the disease while using the condom. All grades of CIN proved to be reversible. It is recommended that a mechanical barrier at intercourse be added to any program for conservative treatment of CIN.

Adult↗
PubMed1982

Examination of the cervix with the naked eye using acetic acid test.

Examination of the cervix was carried out on 2,400 patients, by use of acetic acid test with the naked eye and the colposcope. The physiologic transformation zone was clearly identified both with the naked eye and the colposcope in 1,568 of 1,594 (99%) cases. Colposcopic examination was unsatisfactory in 108 of the 264 (41%) patients in whom the cervix was completely covered by normal squamous epithelium. An atypical transformation zone (ATZ) was identified with the naked eye as white epithelium in 98.4% and as "suspicious" in 1.6% of 312 colposcopically controlled cases. An unsatisfactory colposcopic examination occurred in 39 of the 312 (12.5%) patients with an ATZ. Final histologic diagnosis for 312 ATZs was benign lesion in 169 of 312 (54.2%), cervical intraepithelial neoplasia (CIN) grades 1 and 2 in 81 of 312 (26%), grade 3 CIN in 56 of 312 (17.9%), and preclinical invasive carcinoma in 6 of 312 (1.9%). The detection of intraepithelial or preclinical invasive cervical neoplasias should not depend on the possession of a colposcope. On the other hand, the use of a colposcope is essential for the selection of CIN that can be treated with ultraconservative therapy or with colposcopically directed conization.

Acetates↗
PubMed1987

The value of endocervical curettage in the management of the patient with abnormal cervical cytologic findings.

Patients with adequate colposcopic examinations and dysplasia on the endocervical curettage specimen usually undergo further diagnostic evaluation. This study evaluated 712 patients and found the frequency of positive endocervical curettage specimens to be 17.6%. Cervical conization or hysterectomy specimens were examined in 66 cases with a positive endocervical curettage. Of these, 69.7% had histologic evidence of discontinuous dysplasia in the endocervical canal. The endocervical curettage specimens were grouped by the percentage of endocervical epithelium that was dysplastic: group 1, less than 10%; group 2, 10% to 50%; group 3, greater than 50%. Confirmed histologic endocervical involvement was 80%, 56%, and 60%, respectively. The involvement of the endocervical canal also increased with increasing grade of cervical intraepithelial neoplasia. Of the 66 cases examined with positive endocervical curettage specimens, 62.1% had grade 3 cervical intraepithelial neoplasia on the ectocervix. Seven patients had positive endocervical margins, with six of these occurring in grade 3 cervical intraepithelial neoplasia lesions. Two unsuspected cases of cervical malignancy were identified by endocervical curettage.

Carcinoma↗
PubMed1993

Loop electrosurgical excision procedures for cervical dysplasia: experience in a community hospital.

OBJECTIVE: The study was undertaken to evaluate the use of the loop electrosurgical excision procedure as an outpatient hospital or surgicenter procedure. STUDY DESIGN: The records of 358 patients treated for cervical intraepithelial neoplasia at a large community hospital over a 1-year period were reviewed. RESULTS: The specimens obtained by loop electrosurgical excision procedure and laser cone excision were comparable in size but smaller than those by means of cold-knife conization. Seventy-two percent of loop electrosurgical excision procedure specimens consisted of two to eight tissue fragments (mean 3.4). In addition, 48% of the loop electrosurgical excision procedure specimens and 38% of laser cones had moderate or severe thermal artifacts. Fragmentation and cautery damage precluded orientation of tissue and evaluation of margins in 19% of the cases. CONCLUSIONS: The advent of the loop electrosurgical excision procedure has shifted the management of cervical intraepithelial neoplasia from the office to the outpatient surgery centers. This negates and, in fact, reverses the advantage of loop electrosurgical excision procedure over other methods in regard to cost and convenience through evaluating and treating a patient with cervical intraepithelial neoplasia in one office visit. Loop electrosurgical excision procedures provide specimens that are inferior compared with cold-knife cones; therefore the role of loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia outside the office appears limited.

Adolescent↗
PubMed1981

The diagnosis and management of cervical intraepithelial neoplasia in the patient under the age of twenty-one.

The diagnosis and management of 260 patients between the ages of 15 and 21 with cervical intraepithelial neoplasia is discussed. These patients represented 22% of all new patients seen in the Colposcopy Clinic of The Johns Hopkins Hospital between January 1975 and December 1979. Sixty-six percent of the patients were referred for evaluation of two Papanicolaou smears which were compatible with the diagnosis of CIN I while only 1.5% of the patients were referred with the cytologic diagnosis of CIN III. The colposcopic impression in the majority of patients was CIN I. There was excellent correlation between the colposcopic impression and histopathology. Thirteen percent of the patients evaluated had surgical procedures, 11% (29 patients) under-went conization and 2% (five patients) hysterectomy. The majority of patients under the age of 21 had minimal degree of cervical intraepithelial neoplasia. The importance of conservative management is discussed.

Adolescent↗
PubMed1983

CIN and preclinical cervical carcinoma. A study of morbidity trends over a 10-year period.

Between 1971 and 1980 1312 cone biopsies were performed at the Department of Gynecology and Obstetrics, Kiel. Comparing the two intervals from 1971 to 1975 and 1976 to 1980 the number of cases with dysplasia and Carcinoma in situ significantly rose in the last 5 years in patients 16-30 years of age. Amongst other reasons for this increase, on the basis of our investigation, the regular gynecological examination in combination with the prescription of the ovulation inhibitors seems to be responsible. The average age of patients (36-44 years) undergoing cone biopsy for the first time decreased in the period between 1971 and 1980 (approx. 8 years). The excision of carcinoma in situ in women under 30 years of age mostly showed margins free of pathological epithelium. With increasing age the cases of not free margins increased to 70%. For the hemostasis of the conization crater up to 1977, the conventional suture technique was applied, since 1977 cone coagulation probe according to Semm was used. In this group (1977-1980) treated with coagulation after cone biopsy, 45% of the cases with carcinoma in situ not free margins had histologically normal epithelium of the extirpated uterus. In patients with the desire for a child or in pregnant women a secondary coagulation of the wound crater is achieved to preserve the uterus.

Adolescent↗
PubMed1985

Definition and treatment of microcarcinoma of the cervix uteri.

Patients with tumors without vessel invasion have a better prognosis than patients with tumors of the same size with vessel invasion. The depth of stromal infiltration should be measured from the epithelial surface. In patients with an infiltration less than 1 mm, conization will be sufficient treatment, but hysterectomy is necessary when the disease is more advanced. When the tumor has infiltrated into vessels, additional treatment including pelvic lymphadenectomy or external irradiation should be performed.

Carcinoma↗
PubMed1991

Cervical dysplasia in the postmenopausal female: diagnosis and treatment.

Thirty-two postmenopausal women, age 50 years or older, were colposcoped for abnormal Papanicolaou (PAP) smears. Sixteen had mild to moderate dysplasia, six severe dysplasia and the remainder had no dysplasia. Treatment included observation, topical estrogen, cryotherapy, conization or hysterectomy. Based upon our observations, satisfactory colposcopy can be performed in the majority of postmenopausal women. Oral or topical estrogen is a valuable adjunct in the initial evaluation and treatment of abnormal PAP smears in postmenopausal women. Criteria for adequate colposcopy in postmenopausal women are discussed and a management scheme is proposed.

Aged↗
PubMed1982

Outcome of pregnancy after cone biopsy--a case-control study.

In a case-control study on 79 cone biopsy treated women under 35 yr of age the subsequent pregnancies were followed. The women of the control group were matched to maternal age, parity and the time of delivery. There were more 'abnormal' deliveries in the surgical treated group such as more bleedings, more cervical insufficiencies and a faster descent-time curve of the presenting part of the fetus. The premature frequency was 13.2% in the conized group and only 3.8% in the control group. The study gives support to a primarily more conservative policy in young women with positive smears.

Adult↗
PubMed1992

Prevalence, diagnosis and treatment of lower genital neoplasia in women with human immunodeficiency virus infection.

The prevalence of lower genital neoplasia and Human Papilloma-virus-related genital lesions were evaluated in a cohort of 75 women with Human Immunodeficiency Virus type 1 (HIV-1) infection at different stages of HIV disease. The overall rate of cervical intraepithelial neoplasia (CIN) in the group studied was 29.3% (22/75). Eight out of 10 high-grade CIN lesions contained 'high-risk' HPV-DNA 16/18 and/or 31/35/51 as demonstrated by 'in situ' hybridization with biotinylated probes. Vulvar and/or perianal condylomata were histologically diagnosed in 14 patients (18.7%); nine of these biopsies contained detectable HPV-DNA which was always related to HPV 6/11. The rate of high-grade CIN in symptomatic HIV-infected patients was 28% (7/25) as compared to 6% (3/50) of the other cases (P = 0.022). CD4 lymphocyte counts, white blood cell counts, CD4+/CD8+ cell ratio and percentage of CD4+ lymphocytes were lower in patients with high-grade CIN in comparison to the patients with negative colposcopical and/or cytological examination. After adequate standard treatment (cryotherapy, electrocauterization, cold-knife conization) only one case of CIN 2 recurred during the 2 years of follow-up period. The prevalence of lower genital neoplasia and HPV-related lesions among HIV-infected women is high and seems to correlate with the severity of HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Laser miniconization in mild and moderate dysplasia of the uterine cervix.

Mass cytologic screening for cervical cancer often reveals only mild dysplasia not indicating conization but necessitating continual checkup. Such routine checkups are often insufficient, beside which the patients find them frustrating. Therefore a new method, called miniconization, for treatment of patients with vaginal smears showing mild or moderate dysplasia (cervical intraepithelial neoplasia/CIN/I-II), was developed. With the CO2 laser handpiece a 5-mm-thick disc of the cervix, including the whole transformation zone, was removed. This was followed by endocervical curettage. The advantage of the method over cryosurgery, electrocoagulation, and laser vaporization, for example, is that the tissue specimen as a whole disc including the transformation zone can be sectioned and examined histologically. Another advantage is the decreased risk of postoperative bleeding, which enables ambulant care. One hundred and fifty-one patients have hitherto been treated and carcinoma in situ has been found in 15.2% and microinvasive carcinoma in 1.3% of all these patients in whom vaginal smears showed mild or moderate dysplasia (CIN I-II).

Adult↗
PubMed1985

A study of cryosurgery and the CO2 laser in treatment of carcinoma in situ (CIN III) of the uterine cervix.

The results of laser and cryosurgical treatment in 106 patients with histologically proven carcinoma in situ of the uterine cervix (CIN III) are presented. Seventy-one patients were treated with the laser and in 63 of these further follow-up with colposcopy and cytology failed to show any abnormality. This represents an initial success rate of 89%. In 8 patients (11%) initial treatment was considered to have failed because of persistent dyskaryotic smears and histological evidence of cervical intraepithelial neoplasia (CIN II-III). Six of these patients were treated successfully with a further laser application and two patients had conization. The overall success rate for the laser was 97%. Thirty-five patients were treated with cryosurgery and subsequent follow-up was negative in 29 of these patients (83%). The 6 treatment failures (17%) were subsequently successfully treated with local destructive therapy (4 with cryosurgery, 1 with laser, and 1 with needle diathermy). The overall success rate for cryofreezing was 94.2%. In cases of CIN III the laser is more likely to achieve eradication of the lesion with a single application than cryofreezing.

Adolescent↗
PubMed1989

Adenocarcinoma in situ of the uterine cervix: a clinico-pathologic study of 36 cases.

Thirty-six consecutive cases of adenocarcinoma in situ (ACIS) of the uterine cervix, including 8 cases of early stromal invasion to a depth not exceeding 5 mm, were revised with specific reference to detection rate and treatment. The final histologic diagnoses were based on 31 cone biopsies, 1 hysterectomy specimen, and 4 endocervical curettings/punch biopsies. ACIS was localized in the transformation zone of all cone biopsies/hysterectomy specimen, with a mostly superficial spread in the glands. The mucosal surface was involved in 34 cases. In 29 cone biopsies, ACIS was found unifocal. ACIS was associated with lesions of the squamous epithelium, mostly severe, in 25 cases. On review, all cervical smears were positive and ACIS could be specifically diagnosed in 24 cases. Pretreatment biopsies showed ACIS in 28 cases. Detection of early invasive adenocarcinoma required cone biopsy in most cases. Colposcopy showed no characteristics of ACIS. The detection of ACIS depended on the extension of the lesion. Conization with uninvolved margins was an adequate treatment. Residual ACIS was only found in cases with coexisting early invasive adenocarcinoma. No recurrences or frankly invasive adenocarcinomas have been observed during the observation period.

Adenocarcinoma↗
PubMed1989

A case of glandular intraepithelial neoplasia involving the cervix and vagina.

A case of high grade glandular intraepithelial neoplasia (GIN) of the vagina is described. This lesion developed 5 years after hysterectomy, which had been carried out because of histologically incomplete excision of cervical adenocarcinoma in situ, despite two conizations. The vaginal lesion was treated by local excision and subsequent radiotherapy to the vagina. The literature contains reference to only one case of vaginal adenocarcinoma in situ, which was successfully treated by local excision. The possible histogenesis of this lesion is discussed and recommendations made for follow-up of patients who have received treatment for high grade cervical or vaginal GIN.

Adenocarcinoma↗