Adenocarcinomain situ of the cervix: An underdiagnosed lesion

Abstract

Although invasive adenocarcinoma of the cervix constitutes 5--15% of all cervical cancers, the in situ counterpart is underrepresented in the published series of percursor lesions of cervical cancer. Moreover, no cases are known to have been published in which in situ adenocarcinoma preceded invasive cancer. Partly, this can be explained by the fact that in situ adenocarcinoma is an underdiagnosed lesion. In a series of 52 cases of adenocarcinoma of the uterine cervix, 18 "negative" endocervical biopsies, taken 3--7 years prior to the clinical presentation of cancer, were available for study. In five of these cases, areas of adenocarcinoma in situ were found. The quantitative parameters of these "missed" adenocarcinomas in situ and adenocarcinomas in situ adjacent to invasive cancer were the same. The in situ lesions differed significantly from benign endocervical epithelium. This study strongly suggests that these lesions may progress to invasive cancer. With the acquired information on the quantitative features of adenocarcinoma in situ cells, the most significant criteria for routine diagnostic practice can be identified.

A Longitudinal Swedish Study on Screening for Squamous Cell Carcinoma and Adenocarcinoma: Evidence of Effectiveness and Overtreatment

“…One alternative explanation for the ever-increasing AIS incidence without a corresponding decrease of adenocarcinoma is the possibility that AIS (or a large proportion of AIS) is not a precursor to adenocarcinoma. Although AIS seems to be accepted as a precursor lesion to adenocarcinoma, much of the evidence is circumstantial and/or underpowered (24)(25)(26)(27)(28)(29). A second plausible alternative is that the proportion of AIS that progresses to adenocarcinoma may be even lower than the proportion of CIS that progresses to SCC.…”

Differences in HPV 16- and HPV 18 E6/E7 oncogene expression between in situ and invasive adenocarcinomas of the cervix uteri

“…ACISs/ASCISs have a similar epidemiologic profile relative to their invasive counterparts, with an average appearance 10 years earlier. In addition, reports about a transition of ACISs into invasive ACs were published [3,5,22,30,35,37].…”

Glandular lesions of the uterine cervix: the present state of our knowledge

“…Because of this, a diagnosis of adenocarcinoma in situ cannot be made on punch biopsy (Ostor et al 1984). If overlooked, there is a progression to invasive adenocarcinoma, which takes 14 years on average (Christopherson, Nealon & Gray 1979), but in one series was as short as 3-7 years (Boon et al 1981b). Treatment by cone biopsy with clear excision margins may be curative (Ostor et af.…”