Adenocarcinoma in Situ of the Uterine Cervix: Management and Outcome

Abstract

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

The Status and Distance of Cone Biopsy Margins as a Predictor of Excision Adequacy for Endocervical Adenocarcinoma In Situ

“…4,8,[13][14][15][16][17][18][19][20][21] Most authors believe that a patient with AIS does not require a second cone biopsy or hysterectomy if the margins are free of AIS in the initial cone biopsy specimen. The results of our study generally support this recommendation but they also highlight the context in which the recommendation needs to be made.…”

Histologic Follow-up of Atypical Endocervical Cells

“…9 In addition, cold knife conization, with its higher risk of morbidity, is preferred to large loop excision of the transformation zone (LLETZ), as LLETZ has resulted in greater interfering artifact and higher rates of positive margins and recurrence of adenocarcinoma in situ (AIS). 10,11 Since the ThinPrep Pap Test (TPPT) (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) was approved as a replacement for the CPS in May 1996, a number of studies have reported significantly increased detection of both low and high grade squamous intraepithelial lesions. [12][13][14][15][16] There were fewer studies comparing TPPT to CPS with regard to performance with glandular lesions [17][18][19][20] and only one study specifically comparing the cytologic diagnosis of AGUS-EC.…”

Atypical Papanicolaou Smear in Pregnancy

“…According to the 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities, 24 nearly half the patients with biopsy-confirmed AIS have a coexisting squamous abnormality and, therefore, the presence of a coexisting squamous abnormality does not change the management of women with AGC or AIS. 21,[24][25][26] AGC is a significant indicator of more serious lesions, such as high-grade preinvasive squamous disease, AIS, and invasive adenocarcinoma. [1][2][3][8][9][10][11][12][13][14][15][16] This case illustrates that AGC found upon Pap smear during a pregnancy can be associated with significant pathology for which an aggressive management approach is warranted.…”

“…The rate of positive margins or recurrence for cervical AIS is significantly less when a cold knife conization is performed as opposed to a large loop excision of the transformation zone. 21 A narrow cone incorporating the entire endocervical canal (2.0 cm to 2.5 cm) should be carefully performed to avoid disrupting the endometrium or fetal membranes. 1,9,12,14,16,33,34 For conization under either spinal or general anesthesia, tocolytic therapy with nonsteroidal anti-inflammatory agents should be used to prevent contractions.…”