Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

Abstract

Microinvasive adenocarcinoma (MIAC) of the uterine cervix is rare in pregnancy. Published data on conservative treatment of MIAC both in pregnant and nonpregnant women are scarce. A conservatively treated case of MIAC in a 13-week-pregnant woman after a diagnosis of atypical glandular cells (AGC) on pap smear at the 6th week of pregnancy is presented. The problems of suspected adenocarcinoma in situ (AIS) on biopsy and MIAC on cone biopsy in pregnancy, as well as the risks and benefits of a conservative treatment are discussed. After colposcopic guide laser cervical conization and expression of informed consent the patient underwent followup and vaginal delivery at 40 weeks plus 3 days of gestation. In this case, no obstetric complication has been recorded after the cervical conization, and after a followup of 18 months the patient was alive and free of disease, with negative results as far as pap smear, colposcopy, HPV status, and cervical curettage are concerned. In a stage Ia1 disease of endocervical type, with clear margins and without lymph-vascular space invasion, cervical conization performed during the second trimester may be considered a definitive and safe treatment, at least up to delivery, after expression of informed consent by the woman.

Conservative treatment of coexisting microinvasive squamous and adenocarcinoma of the cervix: report of two cases and literature review

“…In fact, because of multifocal disease and skip lesions, there may be residual or recurrent glandular neoplasia even in the case of apparently negative surgical margins in cases treated conservatively. 32 This situation is more dangerous and feared, since follow-up methods are unreliable for endocervical glandular lesions. 32 Nevertheless, it is now recognized that the histological cell type (squamous or glandular) has no impact on survival for stage I diseases.…”

“… 32 This situation is more dangerous and feared, since follow-up methods are unreliable for endocervical glandular lesions. 32 Nevertheless, it is now recognized that the histological cell type (squamous or glandular) has no impact on survival for stage I diseases. 33 …”

Common Types of Cancer in Pregnancy

“…14 Radiation therapy is contraindicated in pregnancy however some authors stated that radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes. 18,19 Radiotherapy and endocrine or antibody treatment should be postponed until after delivery according to some authors. 20 Surgical treatment may be performed as for non-pregnant women.…”