A case of microinvasive squamous cell carcinoma on the mucosal surface of pedunculated submucous leiomyoma protruding through cervix / 부인종양

Recently, a case of cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma had been reported. We experienced a similar but distinct case of microinvasive squamous cell carcinoma on the mucosal surface of a pedunculated submucous leiomyoma. A 45-year-old Korean woman underwent type I hysterectomy for heavy bleeding from pedunculated submucous leiomyoma. Histopathological examination revealed that the leiomyoma of which mucosa was covered focally by microinvasive squamous cell carcinoma. During the management of pedunculated leiomyoma protruding through cervix, caution must be taken because of, although rare instance, a possible coexisting malignancy.

Management of microinvasive cervical cancer / 대한산부인과학회지

The medical term microcarcinoma of the uterine cervix was first introduced by Mestwerdt in 1947. He proposed that 5 mm was the deepest penetration acceptable. Since then, both terminology and management has been the subject of debate. A more accurate definition of microinvasive carcinoma was adopted by FIGO in 1995. Stage IA1 was defined as a tumor that invaded to a depth of 3 mm or less, whereas stage IA2 referred to a tumor that invaded to a depth greater than 3 mm and up to 5 mm. In both stages, the horizontal spread should not exceed 7 mm. Many patients with early cervical cancer are young, and preservation of fertility is a major concern. Treatment of microinvasive cervical cancer involves appropriate management for both the primary lesion and potential sites of metastatic disease. Both surgery and radiation therapy may be used for primary treatment, although definitive surgery is usually applied to patients with stage IA disease.

A clinico-pathological analysis of microinvasive cervical cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate correlation the of histological variables and the clinical features of microinvasive cervical cancer with the depth of invasion and to establish the adequate therapeutic modality. METHODS: One hundred and thirty-seven patients with microinvasive cervical cancer diagnosed by FIGO (1994) staging were reviewed, who were treated by conization, type I hysterectomy, type II hysterectomy and type III hysterectomy, in Gil Medical center from January 1997 to December 2001. We divided the depth of invasion to three groups of less than 1 mm, 1-3 mm and 3-5 mm. RESULTS: The age of the 137 women ranged from 24 to 71 years (mean age 47.4 years). The number of patients with FIGO stage IA1 and IA2 were 112 and 24, respectively. Of surgically treated 135 patients, lymph node involvement was present in 1 patient with a depth of invasion of less than 1 mm, 2 patients with 1-3 mm and 1 patient with 3-5 mm. Lymph-vascular space involvement was present in 3 patients with 1-3 mm, 4 patients with 3-5 mm. Transient bladder dysfunction was the most common complication after surgical procedures, occupying 5.6%. Other surgical complications included lymphedema (3.6%), wound complication (3.6%), ureter injury (1.1%), lymphocele (1.1%), anal incontinence (1.1%) and dyspareunia (1.1%). CONCLUSION: A management should be individualized. Patients with a depth of invasion of less than 1mm and clear resection margin may be managed by conization. Further follow-up study for a necessity of lymphadenectomy for the group with the depth of invasion of 1-3 mm irrespective of lymph-vascular space involvement is demanded.

A Case of Squamous Cell Carcinoma in Ovary Presented after Treatment of Microinvasive Cervical Cancer / 대한산부인과학회잡지

Squamous cell carcinoma of the ovary is rare. It is considered to be associated with benign cystic teratoma, Brenner tumor and ovarian endometriosis which undergo malignant degeneration in their epithelial layers. Although ovarian metastasis from advanced cervical cancer is well known, however, ovarian metastasis from microinvasive cervical cancer is extremely rare. Because there are few reports about squmaous cell carcinom of the ovary, the pathogenesis is still not well known. Recently we experienced a case of squamous cell carcinoma in ovary presenting 109 months after surgical therapy of a microinvasive cervical cancer. We report this case with a brief review of literature and possible pathogenesis.

A Case of Squamous Cell Carcinoma in Ovary Presented after Treatment of Microinvasive Cervical Cancer / 대한산부인과학회잡지

Squamous cell carcinoma of the ovary is rare. It is considered to be associated with benign cystic teratoma, Brenner tumor and ovarian endometriosis which undergo malignant degeneration in their epithelial layers. Although ovarian metastasis from advanced cervical cancer is well known, however, ovarian metastasis from microinvasive cervical cancer is extremely rare. Because there are few reports about squmaous cell carcinom of the ovary, the pathogenesis is still not well known. Recently we experienced a case of squamous cell carcinoma in ovary presenting 109 months after surgical therapy of a microinvasive cervical cancer. We report this case with a brief review of literature and possible pathogenesis.

Clinical Study of Microinvasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: With the use of regular cervical cytologic screening, an increasing percent of patients with invasive cervical cancer are being diagnosed with early-stage disease. During the past two decades, there has been considerable interest in identifying a group of patients with early invasive cancer who have a minimal risk for extracervical spread. Method: From January 1993 to June 2000, we have experienced 26 cases with microinvasive cervical cancer. The data were collected retrospectively and all charts were reviewed. Result: The age ranged from 29 to 69 years and median age was 44.3 years. 18 cases incidentally found through the routine Pap smear, in symptomatic group most frequent initiating symptom was postcoital bleeding. The corresponding rate of Pap smear to histologic diagnosis was approximately 26.9%. However, corresponding rate within one histologic grade was about 69.2%. The modified radical abdominal hysterectomy was performed in 21 cases and modified radical abdominal hysterectomy with pelvic lymph node biopsy was performed in 4 cases and radical abdominal hysterectomy with pelvic node biopsy was done in 1 case with greater than 3 mm and no greater than 5 mm stromal invasion. There was no surgery-related deaths and recurrent cases in this study. CONCLUSION: The prognosis of stage Ia cervical cancer is relatively good and less radical therapeutic approach may be beneficial. But, further prospective study based on large numbers of cases with multi-institutional cooperation and designed protocol will be necessary.

The clinical experience of LLETZ / 대한산부인과학회잡지

OBJECTIVE: To evaluate how resection margin involvement after LLETZ affect treatment of CIN and microinvasive cervical cancer, and several factors affecting the resection margin involvement. METHOD: Retrospective analysis was performed in 160 patients that underwent LLETZ at Gachon Medical College, Gil Medical Center from March, 1997 to September , 1998. The several factors affecting the resection margin involvement were analyzed. RESULT: The following results were obtained. 1. 127 patients were diagnosized finally with CIN, 30 patients with microinvasive SCC and 3 patients with chronic inflammation. 2. The rate of the negative resection margin involvement was 81% and that of the positive was 19%. 3. No case among 129 cases with the negative resection margin had residual lesion, but 9 cases among 31 cases with the positive resection margin had residual lesion. As a whole, the rate of residual lesion was 6.2%. 4. In CIN, 3 cases of 19 cases with the positive resection margin had residual lesion, but none with the negative resection margin had. 5. The degree of histopathology, glandular involvement, menopause, colposcopic evaluation were correlated with the resection margin involvement but delivery mode and HPV infection not correlated. CONCLUSION: LLETZ is a enough method to reduce unnecessary hysterectomy in the treatment of CIN, if followed up, in spite of the positive resection margin because of low rate of lesidual lesion, and is a effective method in the treatment of microinvasive cervical cancer when the case with negative resection margin and no lymphovascular invasion was followed up.