Endocrine tumors of the uterine cervix: incidence,demographics, and survival with comparison to squamous cell carcinoma

OBJECTIVE: The aim was to describe the epidemiology of endocrine tumors of the cervix in comparison with invasive squamous cell carcinomas using population-based data reported to the Surveillance, Epidemiology and End-Results (SEER) program. METHODS: Retrospective analysis of actively followed cases reported to SEER from 1973 to 1998. Incidence, demographic characteristics, and survival were compared for endocrine and squamous tumors. RESULTS: There were 239 cases of endocrine tumors and 18,458 cases of invasive squamous cell carcinoma of the cervix included in the study. Mean age at diagnosis was 49 years for endocrine tumors versus 52 years for squamous cell carcinoma (P < 0.01). Endocrine tumors were more likely to present at a later FIGO stage (P < 0.01), and to have lymph node involvement at diagnosis (57 vs 18%, P < 0.01) compared to squamous cell carcinoma. Observed median survival for women with endocrine tumors was 22 months versus 10 years for women with squamous cell carcinoma. Age and FIGO stage-adjusted hazards of death were 1.84 times greater for endocrine tumors than for squamous cell carcinoma (95% CI 1.52-2.23). At all stages of disease, survival was worse for women with endocrine tumors compared to women with squamous cell carcinomas. CONCLUSIONS: Endocrine tumors of the cervix are extremely aggressive and survival is poor regardless of stage at diagnosis.     

Histological grading and DNA content as predictors of distant metastases in squamous cell carcinoma of the uterine cervix

Summary Squamous cell carcinoma of the uterine cervix with distant metastases can be treated by adjuvant chemotherapy. The at-risk patients are those with histologically proven metastases, the presence of tumour in paracervical tissue and parametrium, evidence of vascular invasion, a great depth of invasion, or poor tumour differentiation. Our studies lead us to believe that differentiation and DNA content are also important criteria.     

Combination therapy with topotecan,paclitaxel, and bevacizumab improves progression-free survival in recurrent small cell neuroendocrine carcinoma of the cervix

Objectives

To assess if the combination of topotecan, paclitaxel, and bevacizumab (TPB) was active in recurrent SCCC and to compare the survival of patients with SCCC who received TPB to a group of women with SCCC who did not receive this regimen.

An evaluation of chemotherapy in patients with cancer of the cervix and lymph node metastases

During the past twelve years, out of the 288 cervical cancer patients who had lymph node involvement, the recurrence rate in the lymph node, was 26.6% if one or two nodes were involved and 50.8% if three or more nodes were involved (P<0.0001). The recurrence rate of patients who received eight intravenous treatments (at monthly intervals) of multi-agent chemotherapy was lower than those who did not receive treatment. Of patients with one or two positive lymph nodes, 114 received treatment while 50 did not; their respective recurrence rates were 19.3% and 42.0%, a statistically significant difference (P<0.025). Of patients with three or more positive lymph nodes, 97 received treatment and 27 did not, their respective recurrence rates, were 46% and 66% (P=0.30) and the difference is not statistically significant. It would seem that multi-agent chemotherapy may reduce the recurrence rate in patients with cancer of the cervix and positive lymph nodes.AbbreviationCX CA Cervival cancer     

Isolated recurrence at the residual uterine cervix after abdominal radical trachelectomy for early cervical cancer

BACKGROUND: We report an isolated recurrence at the residual cervix shortly after abdominal radical trachelectomy for cervical cancer. CASE: A 34-year-old woman underwent radical abdominal trachelectomy and pelvic lymphadenectomy for FIGO stage IB1 squamous cell cervical cancer. The tumor measured 10 mm in maximum diameter with 4 mm of invasion. Histology showed lymph vascular space involvement with no infiltration of adjacent structures and no pelvic lymph node metastases. Tumor-free resection margins exceeded 15 mm. At the 6-month follow-up examination, cervical cytology showed cells suspicious for recurrent cervical cancer. Abdominal hysterectomy was performed and histology showed an isolated 3-mm recurrence in the residual cervix. The patient is free of disease 8 months after hysterectomy. CONCLUSION: Recurrence at the residual cervix is a potential risk of abdominal trachelectomy for early cervical cancer. Patients should be counseled accordingly and followed closely.     

Surgical treatment for neuroendocrine carcinoma of the uterine cervix.

OBJECTIVE: To identify the best operative approach for neuroendocrine cervical carcinoma (NECC). METHODS: The records of surgically treated patients with stages IB to IIB NECC were reviewed. RESULTS: Of 10 patients who met the study criteria for NECC and underwent radical hysterectomy, 4 had pT1bN0, 4 had pT1bN1, 1 had pT2aN0, and 1 had pT2bN1 disease. Those with pT1bN1 or pT2bN1 disease received postoperative adjuvant radiotherapy and/or chemotherapy, and recurrence occurred in 7 patients (70%). Among these 7 patients, 5 (71%) had a primary NECC tumor with deep stromal invasion and 5 (71%) had extrauterine disease (parametrium and/or lymph node). The recurrences in 6 patients (86%) were located outside the pelvis (lung, liver, or brain). Stromal invasion was 6 mm or less in the 3 patients who did not experience disease recurrence. CONCLUSIONS: Pelvic control by radical hysterectomy may not be beneficial for patients with NECC except for those with an early invasive lesion.     

A survey of gynecologic oncologists regarding the end-of-life discussion: a pilot study

Objectives.

To identify the practices and attitudes of gynecologic oncologists regarding the end-of-life discussion.

Methods.

A pilot survey was sent to 1105 members of the Society of Gynecologic Oncologists (SGO). The survey consisted of 20 questions and was sent via the website Survey Monkey.

Results.

Response rate was 12.8%. Sixty percent of respondents were male, most ranged between 30 and 60 years of age and more than half performed 5-10 major surgeries per week. More than half of respondents (53.9%) deferred the End of Life discussion until the patient had sustained a major change in functional and/or medical status. Thirty percent initiated it at the first recurrence or progression of disease. Forty three percent of respondents characterized the discussion as an on-going process. Patients' age, social support, health insurance, and co-morbidities had no influence on the discussion, and neither did the tumor's site of origin or grade. More respondents initiated the discussion in advanced stage cancer (57%) and after salvage chemotherapy institution (54%). Forty four percent of respondents reported that “understanding and acceptance” was the initial response by patient when counseled about withdrawal of care. This increased to 86% when the issue was revisited. Confusion or reluctance to discuss the subject were initially reported to be 12% and 19%, respectively, but decreased to 2% and 3%, respectively, when withdrawal of care was subsequently addressed with the patient.

Conclusions.

This pilot survey sheds a light on attitudes and practices about the end-of-life discussion that deserve to be further studied.     

Prognostic significance of keratinization in squamous cell cancer of uterine cervix: a population based study

Purpose  To determine the influence of keratinization on prognosis in squamous cell cancer (SCC) of the uterine cervix. Methods  Patients with keratinized squamous cell carcinoma (KSCC) and non-keratinized squamous cell carcinoma (NKSCC) of the cervix were identified from the Limited Use SEER database from 1988 to 2004. A subgroup of patients who did not have radiation or surgery formed the basis to study the natural history of the disease. Data were analyzed using Pearson Chi-square, Student’s T tests. Kaplan–Meier and Cox Regression Proportional Hazards survival analysis was conducted in SPSS and SEER-Stat software. Results  The KSCC group had 3,102 and the NKSCC had 3,751 patients with mean age being 51 and 49 years, respectively (P = 0.001). In general, patients with KSCC were more likely to have advanced stage (FIGO III and IV) disease while patients with NKSCC were more likely to have poorly differentiated neoplasms (P < 0.001). The prevalence of lymph node metastasis remained similar in both histology types (P > 0.05). Overall, the 5-year survival in KSCC was 63.4% as compared to 65.3% in the NKSCC group (P = 0.04). Patients treated by surgery had no difference in survival; however, patients treated by radiation had a median survival in KSCC of 33 months (n = 928, 95% CI 27.7–38.3) as compared to 38 months (n = 1,140, 95% CI 32.1–43.8) in NKSCC (P = 0.03). A total of 165 KSCC and 147 NKSCC patients did not receive treatment. Within this subgroup, the median survival was 10 months (95% CI 5.93–14.07) as compared to 28 months (95% CI 17.9–38.0; P = 0.001) respectively for the two cohorts. In multivariate analysis stage, treatment status, nodal metastasis and keratinization were independent predictors of survival (P < 0.05). Conclusion  This is the largest study reporting on the prognostic importance of keratinization in SCC. KSCC may be less radiosensitive and associated with shorter overall survival. Also, in the natural history of the SCC, keratinization signifies striking reduction in survival.     

Clinical outcome of patients with FIGO stage IA2 squamous cell carcinoma of the uterine cervix

Objective

The objective of this analysis was to present the clinical outcome of the patients with FIGO stage IA2 squamous cell cervical cancer treated at the Department of Obstetrics and Gynecology between 1973 and 2009, and to clarify the discrepancies in clinical guidelines regarding the radicality of treatment applied in patients with stage IA2 squamous cell cervical cancer.

Methods

In our study we enrolled 89 women, diagnosed with FIGO stage IA2 squamous cell microinvasive carcinoma (MIC) in the period 1973-2009. The analysis involved the following parameters women's age at operation, type of operation, cell type, mitotic activity, invasive growth pattern, host defense reaction, lymph-vascular space invasion and patient's survival. Additionally, using the Rainer′s scoring system, the prognostic score for each MIC was calculated.

Results

The mean women's age at operation was 41.48 ± 10.67 years. The mean depth of invasion was 3.09 ± 1.13 mm, and the mean area of carcinoma 4.05 ± 2.40 mm². In 66 (74.2%) women the suggested treatment was conization, according to the Rainer's scoring system and individualization of treatment based on decision of the tumor board. Three of the 89 patients diagnosed with MIC stage IA2 died; only in one patient the cause of death was cervical carcinoma. At the end of the observed period the survival rate was 98.0%.

Conclusion

We may conclude that conservative management of stage IA2 MIC is safe when exact evaluation of tumor extension and surgical margins of the cone are considered, and results in very low risk of recurrence, lymph node disease, and death caused by cancer. We believe that our experience will contribute to the achievement of the international consensus concerning the treatment of IA2 MIC.     

Positron emission tomography application for gynecologic tumors

Positron emission tomography (PET) using fluorine-18-fluoro-2-deoxy-d-glucose (FDG), which originated as a research tool to evaluate glucose metabolism in cancer tissues, has now become an essential imaging modality for determining the appropriate therapeutic management of various cancer patients. The clinical role of FDG-PET for gynecologic tumors has not been established yet, but FDG-PET has come to be considered one of the important imaging modalities for evaluating patients with gynecological cancers. The objective was to review the literature regarding the utility of FDG-PET in the clinical setting of gynecological malignancies. Many articles reported that FDG-PET could be used for staging and restaging in patients with uterine cervical cancer. Although there is limited data about the feasibility of FDG-PET for endometrial cancer, preliminary results for detecting recurrence were promising. Furthermore, FDG-PET has been reported as a useful imaging modality, especially for restaging, in ovarian cancer, although the prognostic value needs to be fully investigated. Currently, a combined PET/computed tomography scanner is available, and its clinical application has begun. It is expected that this modality will contribute to the management of gynecological cancers, as has been reported recently for other malignancies.     

宫颈淋巴瘤样病变与淋巴造血组织肿瘤临床病理对比分析#br#

目的探讨宫颈淋巴瘤样病变(LLL)与淋巴造血组织肿瘤的临床病理学特征、诊断及鉴别诊断。方法收集2007年10月至2021年8月北京大学人民医院病理科诊断的LLL20例,髓细胞肉瘤5例,B淋巴母细胞淋巴瘤/白血病1例,非霍奇金淋巴瘤4例。应用光镜观察、免疫组化染色、EBER原位杂交进行分析。结果中位年龄45岁,9例小于40岁。临床表现为阴道出血。宫颈黏膜表层可见炎症细胞及淋巴细胞,灶片状大细胞。CD20、CD3、CD138等部分阳性,Kappa、Lambda无轻链限制性。随访均健在。淋巴造血组织肿瘤中位年龄54.5岁,6例为绝经后。临床表现:阴道出血,宫颈肿物等。可见弥漫增生的淋巴样细胞,髓细胞肉瘤细胞原始,表达MPO、CD43、CD117等。B淋巴母细胞淋巴瘤/白血病细胞原始,表达CD20、PAX5、Td T等。弥漫性大B细胞淋巴瘤表达及黏膜相关淋巴组织边缘区B细胞淋巴瘤表达CD20。5例死亡(50%)。结论宫颈淋巴瘤样病变预后良好,应与淋巴瘤鉴别。临床病史、病理形态和免疫组化对于诊断女性生殖道淋巴造血组织肿瘤具有重要作用。     

HPV genotyping in neuroendocrine carcinoma of the uterine cervix in northern Thailand

Objective

To determine the distribution of HPV genotypes in cervical neuroendocrine carcinoma (NECA) in northern Thailand, and evaluate the correlation between HPV genotype and clinicopathologic features.

Methods

Samples from 111 women treated for cervical NECA at Chiang Mai University Hospital between 1992 and 2009 were tested for HPV genotype. Samples were formaldehyde-fixed, paraffin-embedded, and tested via nested PCR and dot blot hybridization.

Results

Ninety-seven of the 111 samples were adequate for DNA analysis. HPV DNA was detected in 93 samples, of which 76 (81.7%) were single, 14 (15.1%) were multiple, and 3 (3.2%) were untyped infections. HPV18 was the most common subtype (70 cases, 75.3%), followed by HPV16 (28 cases, 30.1%). Other genotypes included HPV58 (3.2%), HPV52 (2.1%), and HPV33 (1.1%). Collectively, HPV16 and/or HPV18 were found in 83 cases (89.3%). Women with HPV18 infection were significantly younger (42.0 years) than those with non-HPV18 infections (54.1 years) (P = 0.003). Associated adenocarcinoma in situ was more frequently seen among women with HPV18 infection (P = 0.034).

Conclusions

HPV18 infection was predominant in cervical NECA. Variations in HPV genotype may be related to the clinicopathologic features and pathogenetic pathways of NECA. Vaccination against HPV16 and HPV18 might provide protection against cervical NECA in almost 90% of cases.     

宫颈腺癌48例临床病例分析

目的:分析宫颈腺癌的临床病理特点和预后影响因素,探讨其治疗方案。方法:回顾分析2005年1月至2015年12月天津医科大学总医院妇产科收治的48例宫颈腺癌患者的临床病理和随访资料。结果:48例患者中位年龄48.5岁(33~84岁),中位随访时间41月(3~132月)。FIGO分期:I期28例(58.3%),Ⅱ期13例(27.1%),Ⅲ期4例(8.3%),Ⅳ期3例(6.3%);阴道不规则出血27例(56.3%)。5年总生存率37.5%。淋巴结转移者的5年生存率为0(0/6),显著低于无转移者[55.17%(16/29)],差异有统计学意义(P0.05);保留卵巢患者的5年生存率为71.43%(5/7),显著高于不保留卵巢者[42.86%(12/28)](P0.05)。局部肿瘤大小(P=0.045)、淋巴结转移(P=0.000)、FIGO分期(P=0.000)、宫旁转移(P=0.043)、卵巢转移(P=0.044)均是影响复发的高危因素。多因素显示,淋巴结转移(P=0.000)和局部肿瘤大小(P=0.050)是肿瘤复发的独立危险因素。淋巴结转移与FIGO分期显著相关(P=0.000)。结论:局部肿瘤大小和淋巴结转移是影响宫颈腺癌复发的主要因素;早期宫颈腺癌患者保留卵巢不影响生存率。     

Mixed Mullerian tumors of the uterine corpus: a review

The literature relating to mixed Mullerian tumors of the uterine corpus has been reviewed. A critical account of the clinico-pathologic features of these tumors, their prognosis and treatment is presented.     

妊娠期妇科肿瘤手术的麻醉处理

妊娠期妇科肿瘤是临床上发生率较高的妊娠合并症之一。由于此类患者妊娠的特殊性,相应的手术麻醉处理也更为复杂,文章通过分析妊娠期妇科肿瘤的基本要点,相应手术及麻醉对母体及胎儿的影响,探讨麻醉过程中的处理要点,以便于指导临床麻醉工作。     

Risk of borderline ovarian tumors among women with benign ovarian tumors: A cohort study

Objective

A growing number of studies suggest that some ovarian cancers can arise from benign and borderline ovarian tumors. However, studies on the association between benign and borderline ovarian tumors are lacking. We studied the overall- and histotype-specific risk of borderline ovarian tumors among women with a benign ovarian tumor.