Well-Differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis.

Well-differentiated villoglandular adenocarcinoma is a recently described subtype of cervical adenocarcinoma. The tumor of this type is reported to have distinct clinicopathologic features and excellent prognosis. However, lymph node metastases of this tumor have been described in few reports. Fifteen cases of well-differentiated villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai Hospital were retrospectively reviewed for both clinical and histopathological features. All patients underwent radical hysterectomy with pelvic lymphadenectomy. In the cases with lymph node metastasis, adjuvant radiation therapy was also given. The patients ranged in age from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB and one was stage IIA. All patients had exophytic friable cervical masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean, 2.3). Eleven tumors (73.3%) were confined to the inner third of the cervical stroma with 9 of these (60%) showing only superficial invasion (depth < or = 3 mm). The tumors invaded deeply to the middle third in 3 cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion was observed in 3 cases, two of them had pelvic lymph node metastasis. Both patients had tumors involving deeper than the inner third of the cervical wall. The follow-up duration ranged from 21 to 144 months (mean, 67.5). Four of thirteen cases without nodal metastasis were lost to follow-up 36 to 59 months after surgery. All patients showed no evidence of disease at the last visit. Presence of lymphatic invasion and deep stromal involvement appeared to be the risk factors for lymph node metastasis of well-differentiated villoglandular adenocarcinoma.

Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang Mai Hospital: problems in pathologic evaluation.

BACKGROUND: Loop electrosurgical excision procedure (LEEP) is widely used in diagnosis and management of cervical lesions. Difficulties in histopathologic evaluation of LEEP specimens, particularly for the margin status, have been reported to be a significant disadvantage of the procedure. METHOD: The histologic slides of the specimens from 163 patients who underwent LEEP at Maharaj Nakorn Chiang Mai Hospital from August 1995 to November 1997 were retrospectively reviewed for the degree of thermal artefact and the margin status. Follow-up data after a 6-month-period were correlated with the margin status. RESULTS: Thermal artefact was present in all cases (mild 51.5%, moderate 36.2%, and severe 12.3%). In only one case, histologic diagnosis of the lesion was not possible due to severe thermal artefact. Nine cases (5.5%) had non-evaluable margins due to either thermal artefact (7 cases) or improper orientation of fragmented tissue (2 cases). Of 90 cases with subsequent surgical specimens, residual diseases were present in 4 of 21 (19.0%) with negative LEEP margins, in 31 of 64 (48.4%) with positive margins, and in 4 of 5 (80.0%) with non-evaluable margins. CONCLUSIONS: Pathologic evaluation of the specimens from LEEP was limited in only a minority of cases. Thermal artefact was not a critical disadvantage of LEEP. The positive or negative margin status was correlated with the risk of residual disease.