Microinvasive cervical adenocarcinoma (FIGO stage 1A tumors): results of surgical staging and outcome analysis.

Although studies suggest that microinvasive cervical adenocarcinoma has an excellent prognosis, none has reported treatment-related complications and many have lacked detailed measurement criteria. Our study looks at the rate of lymph node metastases and outcome, including complications, in patients with FIGO 1A1 and 1A2 adenocarcinomas of the cervix. Invasion was strictly defined, and the method of measurement was standardized. Villoglandular, papillary serous and clear cell carcinomas were excluded, as were tumors in which invasion exceeded 7 mm in width or 5 mm in thickness, with tumor thickness measured from the basement membrane of the overlying endocervical or ectocervical surface to the deepest focus of invasive tumor. A mean follow-up of 54 months (range, 5-159 months) was available for 31 of 32 (97%) patients. A total of 29 of 32 patients underwent hysterectomies, 2 patients had radical trachelectomies, and 1 patient was treated by cone biopsy. One patient received adjuvant radiotherapy. A total of 27 of 32 patients had bilateral pelvic lymph node dissections, and no lymph node metastases were identified. No recurrences have been reported to date. One patient died of metastatic ovarian carcinoma 82 months after her diagnosis of cervical carcinoma. Two of 27 (7%) patients have chronic leg edema secondary to lymph node dissection. Given the excellent prognosis of this tumor, the absence of lymph node metastases and a lymph node dissection complication rate of 7%, less radical surgery should be considered in this low-risk patient population.

Gastrointestinal stromal tumor presenting as a recurrent vaginal mass.

Gastrointestinal stromal tumors are CD117 (c-Kit)-positive mesenchymal neoplasms with histologic and ultrastructural features of the interstitial cell of Cajal. While tumors outside of the gastrointestinal tract have been described, to our knowledge the case we present is the first such case in the vagina. We describe a 75-year-old woman with a recurrent vaginal gastrointestinal stromal tumor without apparent rectal involvement. This tumor was characterized by short intersecting fascicles of spindled cells, focal necrosis, and 12 to 15 mitoses per 50 high-power fields. Immunohistochemistry revealed diffuse cytoplasmic positivity for CD117 (c-Kit), CD34, vimentin, and h-caldesmon. Tumor cells were negative for S100, desmin, actin, and CAM 5.2. The differential diagnosis in this case included a vaginal smooth muscle tumor. While histologically similar to a smooth muscle neoplasm, the immunohistochemical profile ruled out smooth muscle differentiation. Gastrointestinal stromal tumor should be considered in the differential diagnosis of vaginal mesenchymal neoplasms.