Isolated lymph nodal recurrence after 10 years in FIGO Stage IA1 cervical adenocarcinoma treated with conization: case report and review of the literature

Abstract

Background. Cervical cancer (CC) represents the fourth most common cancer in women. Since about 25% of women with CC has 40 years or less, more and more women choose fertility-sparing surgery (FSS). FSS, such as conization, represents valid and safe procedures for patients with IA1 tumors without lymph-vascular involvement (LVSI); It has been established that, for this very early stage, the risk of node involvement is negligible (~ 1 %), that is why nodal staging can be skipped M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n 2 and definitive conization can be considered a curative treatment. The issue is that a wide consensus regarding the most appropriate follow-up protocols after FSS has not been achieved. Case presentation.It is reported a very unusual recurrence of cervical adenocarcinoma that is characterized by the site of metastasis that occurred at nodal level, instead of the most common recurrence site that is the cervix, and for the "time to recurrence" that was astonishing long because it occurred at 10 years after conization. Only English studies and those performed in humans were considered to compare the case study to the actual literature. 10 eligible studied were found.Conclusions. Undoubtedly, because of the rarity of the event, it is not possible to reach a clear conclusion. However, the analysis of this case report could be an opportunity to generate new hypothesis about natural history of the disease and to question the safety of FSS when applied outside the actual indications. It is of paramount importance to never lower our guard even on the very early stages, focusing on oncological secondary prevention. It reflects the importance of build a stricter follow up for these patients until new strong medical evidence will be showed.