Villoglandular adenocarcinoma in situ of intestinal type of the hymen: de novo origin from squamous mucosa?

Adenocarcinomas of the lower genital tract are rare diseases, and most of them arise from the Bartholin glands. Villoglandular adenocarcinoma of intestinal type is a very uncommon neoplasm of unknown origin with only few cases described on the vulva and in the vagina. It is characterized by villoglandular architecture, mucinous-type epithelium with intestinal differentiation (goblet cells), and direct apposition of the tumor with the surface epithelium. We report a case that developed on the hymen of a 64-year-old woman and discuss its possible origin as arising de novo from the squamous epithelium.

Long-term surveillance is required for all women treated for cervical adenocarcinoma in situ.

OBJECTIVE: To measure the recurrence rate of disease in women treated for cervical adenocarcinoma in situ (ACIS) by either hysterectomy or conservative surgical management. PATIENTS AND METHODS: One hundred patients with a histopathologic diagnosis of ACIS or glandular dysplasia were identified in a retrospective clinicopathological review. Sixty-seven of the 100 patients were managed conservatively by local excision and were followed up for a mean period of 59 months (range, 1-222 months). The remaining 33 patients underwent hysterectomy as the primary management method and were followed up for a mean of 88 months (range, 1-248 months). If there was histologic documentation of ACIS or invasive adenocarcinoma more than 1 year after treatment, this was considered a recurrence. RESULTS: A total of four recurrences were noted in the 100 patients, three in the conservatively managed group and one in the hysterectomy group. Two late recurrences were noted at 97 and 153 months, one each in the conservatively managed and hysterectomy groups. CONCLUSIONS: Women who have been treated for cervical ACIS require long-term surveillance for at least 10 years regardless of whether they have undergone hysterectomy or conservative management.

Histopathologic score predicts recurrence free survival after radical surgery in patients with stage IA2-IB1-2 cervical carcinoma.

BACKGROUND: The authors evaluated clinical and pathologic factors that predicted for recurrence after patients underwent radical surgery for International Federation of Gynecology and Obstetrics (FIGO) Stage IA(2)-IB(1-2) cervical carcinoma and developed a simple method of scoring those predictive factors to quantify outcome. METHODS: An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox proportional hazards regression analysis was done for each of the individual factors to estimate individual risk ratios using all available data for each factor. Stepwise and best-model options were used to identify the best combinations as predictors and to calculate adjusted risk ratios. Based on the information obtained, each patient was assigned a categorical score to predict recurrence. The variables used for the score were dichotomized. The differences between the scores in time to recurrence were evaluated using the log-rank test to compare the time to recurrence curves that were generated with the Kaplan-Meier method. RESULTS: Eight hundred seventy-one patients were included in the study, and 66 patients who developed recurrent disease after a median follow-up of 49 months. Tumor size, maximum depth of invasion, pelvic lymph node status, tumor grade, and capillary lymphatic space (CLS) were single predictors for recurrence, and the score, which was based on combinations of these factors, predicted the disease free survival. Maximum depth of invasion, pelvic lymph node status, and CLS were the best combined predictors for recurrence, and they were used to form a second, precise scoring system to predict disease free survival (P < 0.0001; log-rank test). CONCLUSIONS: The scoring system based on maximal depth of invasion, CLS, and pelvic lymph node metastases identified four strata of patients with distinct recurrence free survival. The incremental presence of each factor decreased recurrence free survival after patients underwent radical surgery. Patients with the presence of all three factors had a 5-year recurrence free survival rate of 65%. These patients would be suitable for studies of postoperative adjuvant therapy to improve outcome.