As other institutions have reported [4], we have been enObjective: To retrospectively review the management of adeno-countering patients with cervical adenocarcinoma in situ carcinoma in situ of the uterine cervix, to determine the outcome with increasing frequency. The aim of the present study was of conization versus hysterectomy, and to compare the results to retrospectively review the Cleveland Clinic Foundation's achieved by different methods of conization. Methods: We per-clinical and pathologic experience with this neoplasm to formed a retrospective pathology and chart review of 46 patients further address these unresolved issues of patient managewith cervical adenocarcinoma in situ from January 1980 to Octo-ment and outcome. In particular, we wished to correlate the ber 1994. Results: Nine patients were managed during the first pathologic features of this disease with the long-term success half of the study period and 37 were managed in the second half.and feasibility of conservative management. institution if all pathologic materials were then reviewed and the patient was subsequently managed at the Cleveland Clinic. INTRODUCTIONAdenocarcinoma in situ was defined by standard criteria [12]. All histologic slides were retrieved and jointly reSince its original description in 1953 [1], adenocarcinoma in situ of the uterine cervix has been a perplexing and troubling viewed by two pathologists (T.M.M. and W.R.H.) to confirm the diagnosis of adenocarcinoma in situ, to exclude invasive entity for gynecologists. Information regarding the natural history of this lesion has been limited [2][3][4][5][6]. As a consequence, carcinoma, and to assess the involvement of resection margins. The reviewed specimens included all available biopconservative management of this disease, i.e., cervical conization, instead of hysterectomy, remains controversial [7][8][9]. sies, endocervical curettings, conization specimens, and hysterectomy specimens. The extent of the adenocarcinoma in Since most women with adenocarcinoma in situ are of reproductive age, this issue is critical to their management. Concerns situ was approximated by assessing the number of cervical quadrants involved on the initial conization specimen. Assoregarding the reliability of cytologic screening to detect both primary and recurrent adenocarcinoma in situ [5,6] coupled ciated neoplastic and dysplastic intraepithelial squamous lesions (CIN) were noted. with the lack of accepted colposcopic diagnostic criteria [10, 11] have heightened the controversy.Medical records were abstracted to determine all pertinent 304

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