Cellular immunity in squamous cell carcinoma of the uterine cervix.

The thymus-dependent immunity of 42 patients with SCCC was evaluated by: delayed cutaneous reactions to ubiquitous antigens, DNCB sensitization, and lymphocyte response to PHA. In addition, T and B lymphocytes were detected in peripheral blood and in tumor sections, by adherence to E and HEAC. Depressed CMI was more intense in patients with disseminated disease, although a premature impairment of CMI was observed in some patients with initial-stage tumors. The absolute number of peripheral T lymphocytes showed association with both cutaneous reactions and PHA response. However, there appeared to be no significant correlation between the stage of the tumor and the pattern of adherence of E or HEAC to the biopsies.     

The treatment of microinvasive squamous cell carcinoma of the uterine cervix.

Between 1947 and 1971 254 cases of microinvasive carcinoma of the uterine cervix were treated in this institution. Cervical cytology was used to detect the cervical abnormality and the diagnosis of microinvasion was established by cone biopsy. During this time period microinvasion was defined as the breakthrough of the basement membrane and the penetration of neoplastic epithelium into the stroma to a depth of no greater than 5 mm, and excluded those cases which had lymph or blood vessel involvement, a dentritic or staghorn pattern, many epithelial cells in clusters in the stroma, or the presence of confluence. Of the 254 cases, 250 were followed for 5 years or more. Treatment methods for microinvasive cervical cancer over this time period included surgery alone, radiotherapy alone, or a combined approach using both surgery and radiotherapy. None of the 125 cases treated by surgery alone have died of cervical cancer. It is concluded that microinvasive carcinoma, as defined in this study, can be cured by conservative surgical means.     

Coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix

The clinical and pathological features of 20 patients with coexistent squamous cell carcinoma and adenocarcinoma of the uterine cervix have been analyzed. Various combinations of in situ and invasive carcinomas were found. Located adjacent to each other and at times intermingling, these lesions probably originated from the subcolumnar reserve cells of the transformation zone. They are early lesions and may be precursors of adenosquamous and mucoepidermoid carcinomas of the cervix. The diagnosis of these double carcinomas depends upon being aware that the two entities may coexist in the same cervix. Treatment is conventional, and the prognosis is not worsened by the presence of the two types of neoplasms.     

Hepatic resection for metastatic squamous cell carcinoma from the uterine cervix.

A solitary hepatic tumor was diagnosed 3.5 years after a 67-year-old woman had undergone radical hysterectomy and postoperative irradiation for stage Ib squamous cell carcinoma of the cervix. Hepatic resection confirmed squamous cell carcinoma that had metastasized from the uterine cervix. One year and 10 months following hepatic resection, this patient is doing well with no evidence of any recurrence. This is a report of successful hepatic resection for metastatic carcinoma from the uterine cervix.     

Oncogenesis of squamous carcinoma of the uterine cervix.

Carcinoma of the uterine cervix is the most frequent neoplasm among women in India, accounting for up to 85% of all female gynecological malignancies. In the United States, it accounts for about 48% of all female tumors and 4% of all cancer deaths of females. Epidemiological evidence suggests involvement of numerous risk factors in the etiology of cervical cancer, including sexual behavior, number of pregnancies, cigarette smoking, and venereal disease. Recent studies, however, tend to emphasize viral involvement in the development of cervical cancer along with concomitant cytogenetic and immunological changes. This review focuses on the roles of human papillomavirus infection, chromosomal abnormalities, and immune function changes in the pathogenesis of cervical carcinoma.     

子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

Early squamous cell carcinoma of the uterine cervix. I. Definition and histology

Different names and histopathologic definitions concerning early squamous cell carcinoma of the uterine cervix cause divergent opinions on the treatment of this lesion. From a prognostic and therapeutic viewpoint, it is advisable to distinguish two microscopic forms of this early cancer: early stromal invasion and microcarcinoma. While in early stromal invasion, only isolated, variably shaped projections with early signs of infiltration occur, in microcarcinoma, one already finds true confluent carcinomatous masses. The extent of the neoplastic stromal infiltration in microcarcinoma is limited. Tumor length and width amount at most to 10 mm and depth to 5 mm. The tridimensional definition of the size of the tumor requires a very careful histologic workup and diagnosis. Only then can microscopic diagnosis of early stromal invasion and microcarcinoma be reliably made and a definite separation from carcinoma in situ on one side and from advanced carcinoma on the other side be guaranteed.     

Local immune response in squamous cell carcinoma of the uterine cervix

The role of Langerhans cells as antigen-presenting cells was examined in cervical carcinomas. Frozen samples were obtained from 34 women with stage Ib and II cervical carcinomas. Langerhans cells (CD1), T lymphocytes (CD4 and CD8), B lymphocytes (CD22), and natural killer (CD57, NK) cells were all quantitatively assessed in cervical carcinomas using immunohistochemical methods. These results were related to the MHC class I and II expression on the tumor cells. The majority of Langerhans cells were distributed among cancer cells and they were positively correlated with CD4+, NK and B cells in cervical carcinomas. This is suggestive of the presence of local immune response. The numbers of Langerhans, CD4+, CD8+ and NK cells did not significantly correlate with age at operation, lymph node metastases or depth of cervical wall invasion. The downregulation of MHC class I expression found in 8 (24%) carcinomas was not associated with the decrease in the number of immunologic cells. The upregulation of MHC class II expression found in 26 (76%) carcinomas was significantly associated with the increase in the number of Langerhans cells (p < 0.007). However, the association between the upregulation of MHC-II expression and CD4+ cells did not reach statistical significance (p < 0.07). This is probably due to a small case in this study. MHC-II-restricted immunity may partly contribute to the local immune response in stages Ib and II squamous cell carcinoma of the uterine cervix.     

Sarcomatoid squamous cell carcinoma of the uterine cervix: case report

Sarcomatoid squamous cell carcinoma (SSCC) is a recognized entity, usually involving the upper aerodigestive tract and skin. Location in the lower female genital tract is rare. Only 11 cases have been previously reported, four of which arose in the uterine cervix. The authors describe the case of a 39-years-old woman with SSCC of the uterine cervix in Stage I of the International Federation of Gynecology and Obstetrics (F.I.G.O.) classification. The patient died of disease 12 months after diagnosis. Similar cases described in the literature are also reviewed.     

Epidemiological differences between adenocarcinoma and squamous cell carcinoma of the uterine cervix

Adenocarcinoma of the uterine cervix was significantly more common than squamous cell carcinoma of the cervix in unmarried patients (relative risk 2.07) and in nulliparous patients (relative risk 1.96). It also occurred more often in women with arterial hypertension (relative risk 3.62), previous subtotal hysterectomy (relative risk 3.89), and agrarian life style (relative risk 2.95). No difference was noted in mean age, age distribution, age at marriage, age at first delivery, menarche, or menopause. No association of adenocarcinoma of the cervix with pregnancy was found. On the basis of common risk factors it is suggested that cervical adenocarcinoma is epidemiologically more closely related to endometrial adenocarcinoma than to squamous cell carcinoma of the cervix.     

Cytogenetic and cytometric analyses in squamous cell carcinoma of the uterine cervix

Cytometric methods allow a division of tumors into a near-diploid and an aneuploid group. In most carcinomas, aneuploidy has been associated with poor prognosis, but as regards squamous cell carcinomas of the uterine cervix, the results are conflicting. The introduction of flow cytometry, a reliable and rapid method for determination of ploidy level and S-phase rate, has resulted in a renewed interest in cytometric studies of cervical carcinomas. In this article, DNA content, S-phase rate, and tumor heterogeneity are reviewed, as well as correlations found between DNA patterns and stage, age, menopause, differentiation, malignancy grading systems, ABH blood group antigens, and prognosis. In summary, aneuploidy is more common in stages III and IV and correlates to aggressive histopathology, but because of a higher degree of radioresponsiveness, the biological differences between aneuploid and near-diploid tumors are not consistently reflected in prognosis. High S-phase rates are correlated both to aggressive histopathology and impaired short-term prognosis.     

Intraarterial cis-platinum in the management of squamous cell carcinoma of the uterine cervix

Intraarterial cis-platinum was infused by hypogastric artery catheters in nine patients with squamous cell carcinoma of the uterine cervix. The dose of cis-platinum was 120 mg/m² and the infusion was repeated at 4-week intervals. Six patients had pelvic recurrences following radiation therapy and three had large-volume, primary cancers not amenable to conventional therapy. Three patients experienced partial tumor regression (greater than 50% reduction in measured diameters persisting for 3 months), while six had progressive disease. Five patients achieved substantial palliation. Toxicity was similar to that seen with systemic administration. There were no significant catheter complications.     

Tumor size and lymph node metastases in squamous cell carcinoma of the uterine cervix.

Tumor size was accurately measured in 684 patients who had surgical treatment of cervical carcinoma after a small biopsy and received no preoperative radiotherapy. Frequency of lymph node metastases increased as five different tumor size parameters went up, depth of tumor invasion being of particular importance. When micrometastases, macrometastases, and tumor cell emboli were considered, a correlation was statistically verifiable for micrometastases and macrometastases. Such correlations could not be determined for tumor cell emboli. They are to be regarded as a random event.     

Early squamous cell carcinoma of the uterine cervix. III. Frequency of lymph node metastases.

In the literature, the reported frequency of lymph node metastases in early cervical cancer is up to 10%. A review of the reported cases and our own studies reveals that, according to our own definition of early cervical cancer (early stromal invasion and microcarcinoma), metastatic involvement of pelvic lymph nodes occurs in less than 1% of the cases. In every case, the involved lymph nodes were located on the pelvic wall and never in the parametrium. This fact has therapeutic implications.     

Radiation therapy for elderly patient with squamous cell carcinoma of the uterine cervix

OBJECTIVE: The purpose of this study was to profile cervical squamous cell carcinoma in elderly patients undergoing radiation therapy and to study the treatment outcome and side effects of therapy. MATERIALS AND METHODS: A retrospective analysis was carried out from the records of 380 patients with squamous cell carcinoma of the uterine cervix who had been given radiation therapy between 1970 and 1994. The patients were divided into three age groups: under 70 years (youngest group; n = 215), 70 to 79 years (intermediate group; n = 124), and 80 years or older (oldest group; n = 41). Radiation therapy was performed by a combination of external beam therapy and three brachytherapy fractions using low-dose-rate sources. RESULTS: The 5-year overall survival rates in the youngest, intermediate, and oldest groups were 58, 50, and 33%, respectively, while cause-specific survival rates were 68, 70, and 65%, respectively. For the patients with stage III, the 5-year overall survival rates in the youngest, intermediate, and oldest groups were 59, 48, and 36%, respectively, while cause-specific survival rates were 72, 70, and 70%, respectively. There was no statistical significance in the 5-year intrapelvic recurrence rates among the three groups. Grade 3 or 4 complications occurred in 6.5% of the youngest, 11.3% of the intermediate, and 7.3% of the oldest groups. CONCLUSION: Radiation therapy with external beam combined with three fractions of low-dose-rate brachytherapy proved both highly effective and safe for senior patients with cervical squamous cell carcinoma.