Some epidemiologic aspects of carcinoma of the vulva in Israel

A nationwide study of squamous cell carcinoma of the vulva in Israeli Jewish women has been conducted for a comparison of the incidence, the age pattern and the ethnic distribution of squamous cell carcinoma of the vulva to those of squamous cell carcinoma of the cervix. The mean annual incidence rates by age in squamous cell carcinoma of the vulva rise continuously to age 70+ while in squamous cell carcinoma of the cervix a plateau is reached at age 40 to age 69. In contrast to the relatively low incidence of squamous cell carcinoma of the cervix in Israeli Jewish women, the age-specific incidence rates of squamous cell carcinoma of the vulva are similar to those of white women in the United States. On the other hand, there is a trend to a higher incidence of both squamous cell carcinoma of the cervix and squamous cell carcinoma of the vulva in the North African ethnic group of Israeli Jewish women.     

Primary in situ squamous cell carcinoma of the endometrium,with extensive squamous metaplasia and dysplasia

BACKGROUND: Primary squamous cell carcinoma of the endometrium is exceedingly rare. It has been described in association with pyometra but its etiology is still unclear. CASE: The authors report the case of a 75-year-old woman who presented with pelvic pain and pyometra. No gross tumor was identified in the uterus; however, extensive epidermalization of the endometrial mucosa was noted. Microscopic findings were consistent with a primary in situ squamous carcinoma of the endometrium associated with extensive squamous metaplasia and areas of dysplasia. HPV antigen and DNA detection were negative in both the endometrial lesions and the cervix. CONCLUSIONS: These results support the sequence of change with squamous metaplasia, progressing through dysplasia to carcinoma as a possible pathogenetic process. HPV's role, however, remains uncertain.     

Cervical cancers in uterus didelphys

Two cases of cervical cancer in uterus didelphys are presented. One was extensive adenocarcinoma and one was squamous cell carcinoma in situ. In both cases the cancers appeared to have originated separately in each cervix.     

A suggested columnar cell morphological equivalent of squamous carcinoma in situ with early stromal invasion

Cervical squamous carcinoma in situ with early stromal invasion has recently been defined as a strict histologic entity. Two cases of extensive classical adenocarcinoma in situ of the uterine cervix and one of very early invasive adenocarcinoma are reported that showed foci indistinguishable from squamous early stromal invasion arising directly from unequivocally glandular in situ malignant foci. This finding is further evidence in support of the theory that glandular and squamous intraepithelial neoplasia in the cervix are closely related conditions, possibly with a common origin in the subcolumnar reserve cell.     

宫颈鳞癌和腺癌中微血管密度和基质金属蛋白酶-2 、9及其抑制剂-1、2表达的研究

目的通过观察肿瘤微血管密度(MVD)及MMP-2、MMP-9和TIMP-1、TIMP-2在宫颈鳞癌与腺癌组织中的表达情况,在蛋白水平探讨宫颈腺癌较鳞癌恶性程度高的可能原因.方法采用免疫组织化学方法(SP) 检测40例宫颈鳞癌和20例宫颈腺癌组织的MVD和MMP-2、MMP-9、TIMP-1、TIMP-2蛋白的表达情况.结果MVD在宫颈腺癌中较鳞癌高.MMP-2在宫颈鳞癌的阳性表达强度较腺癌高(P=0.006);MMP-9、TIMP-1在腺癌的阳性表达较鳞癌高(P=0.078,P=0.000);TIMP-2在两组间比差异无显著性(P＞0.05).在宫颈癌的临床病理特征中,MMP-2和MMP-9在鳞癌和腺癌中的表达不一,而TIMP-1始终是在腺癌中的表达较鳞癌高.结论宫颈腺癌较鳞癌恶性程度高的原因,可能与较高的MVD和TIMP-1的高表达有关.     

A new marker of maturation in the cervix: the estrogen-regulated 24K protein

The presence of an estrogen-regulated protein (24K) in normal, dysplastic, metaplastic, and neoplastic cervical epithelium correlates with histologic criteria for squamous cell maturation. The 24K protein, originally discovered in the MCF-7 breast cancer cell line, was studied in 51 cases by the modified immunoperoxidase Avidin-Biotin Complex method, using an anti-24K mouse monoclonal antibody. Immunostained sections were compared to hematoxylin-and-eosin-stained sections cut from the same tissue block. The 24K protein was observed to be located primarily in the parabasal or "prickle cell layer" of normal cervical tissue (6 of 7 normal cervical tissue specimens tested were positive for 24K protein. Specimens were obtained from surgery for nonneoplastic causes) and in all cases (12 of 12) of dysplasia and carcinoma in situ. Intercellular bridges of these cells showed prominent immunostaining in normal cervix and dysplasia. 24K protein was observed as a granular cytoplasmic stain in all cases of squamous metaplasia (5 of 5) and keratinizing squamous cell carcinoma (9 of 9), and in 8 of 14 cases of nonkeratinizing squamous cell carcinoma. In this latter group, immunostaining was confined to only those cells showing cytoplasmic eosinophilia on H&E sections. In no case was the presence of the 24K protein associated with areas of mature keratin. 24K immunostaining was also observed in the reserve cells of morphologically normal endocervical glands adjacent to areas of dysplasia and carcinoma. We conclude that 24K protein is associated with squamous cell maturation and may be an important marker of reserve cell hyperplasia and squamous metaplasia.     

Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment—a case report

Metastatic carcinoma in an abdominal wall incision from internal malignant neoplasm is an uncommon and often a preterminal event. Most commonly metastatic skin incisional cancers have been reported with cancers of colon, kidney, and bladder. Incisional metastasis from postoperative case of carcinoma cervix is very rare. It has been reported in few patients with adenocarcinoma and poorly differentiated histopathology, more so at drain site postoperatively. We report a postoperative case of squamous cell carcinoma cervix FIGO stage IIA in a patient who after 3.5 years of completion of radical treatment (postoperative external and intravaginal radiation therapy) developed incisional skin metastasis followed by extensive subcutaneous metastasis in the vulval region. She received salvage chemotherapy; however, she did not show any response and finally succumbed to the disease. The outcome of patients with incisional skin metastasis is usually poor as they are often associated with locoregional recurrence. The intent of treatment remains palliation either by radiation/chemotherapy/surgery alone or in combinations. As far as we know, this is the first case of squamous cell carcinoma cervix stage IIA having incisional scar recurrence 3.5 years after postoperative radiotherapy.     

Serum seromucoid preinvasive and invasive cancer of the uterine cervix

Serum seromucoid concentration has been estimated in patients with cervical dysplasia, and preinvasive and invasive squamous cell carcinoma of the cervix. Significantly elevated levels were found in preinvasive carcinoma and all stages of invasive carcinoma compared to controls. The more extensive the carcinoma, the higher was the serum seromucoid concentration. After treatment the serum seromucoid concentration fell in all patients.     

Carcinoembryoinc antigen in cervical and vulvar cancer patients. Serum levels and disease progress.

Serial carcinoembryonic antigen (CEA) assays were performed on 10 patients with primary invasive squamous cell carcinoma of the cervix, 7 patients with recurrent squamous cell carcinoma of the cervix, and 5 patients with invasive squamous carcinoma of the vulva. Plasma CEA determinations were accomplished by radioimmunoassay, using a modification of Hanson's method. In 8 of the 10 patients with invasive squamous cell carcinoma of the cervix, positive CEA values dropped to normal ranges during the course of radiotherapy, usually in the first 4 weeks of treatment. A similar decrease in patients' serum values was seen after surgical extirpation of recurrent squamous cell carcinoma of the cervix by pelvic exenteration. Serum values also dropped to within normal limits in a limited number of patients with squamous cell carcinoma of the vulva after complete removal of all gross disease. Persistence of disease was associated with all gross disease. Persistence of disease was associated with chronically elevated values. A suggestion is made that patients with elevated CEA values may be followed with serial determinations to substantiate complete eradication of their disease.     

Bilateral ovarian squamous cell carcinoma with an antecedent dermoid cyst in the left ovary

Ovarian squamous cell carcinoma is a rare malignancy and its occurrence is commonly attributed to malignant transformation of a pre-existing mature cystic teratoma. The de novo occurrence of primary squamous cell carcinoma is extremely rare. Malignant transformation in a mature cystic teratoma is almost always unilateral; however, there have been isolated reports of an uncomplicated mature cystic teratoma in the contralateral ovary. We report here a case of a 40-year-old woman presenting with squamous cell carcinoma of both ovaries with antecedent dermoid cyst in the left ovary, along with involvement of the fallopian tubes, cervix and omentum.     

Comparison of adenocarcinoma and squamous cell carcinoma of the uterine cervix: a population-based epidemiologic study.

OBJECTIVE: Our objective was to compare epidemiologic and clinical characteristics of adenocarcinoma with those of squamous cell carcinoma of the cervix, with respect to risk by ethnic group, age at diagnosis, stage of disease at diagnosis, and survival. STUDY DESIGN: All data were obtained from the Cancer Surveillance Program of Orange County, California, from 1984 through 1989. A total of 152 cases of adenocarcinoma and 457 of squamous cell carcinoma of the uterine cervix were included. RESULTS: Adenocarcinoma of the cervix was diagnosed at a younger age and an earlier stage than squamous cell carcinoma. Hispanics have the highest risk for squamous cell carcinoma, whereas Asians have the highest risk for adenocarcinoma compared with whites. No differences were observed between the two histologic types in prognosis and survival. CONCLUSION: Differences between the two histologic types of cervix cancer were found in the age at diagnosis, the extent of disease, and the ethnic distribution. In spite of these differences, prognosis and survival were not affected by histologic type.     

A comparison of ovarian metastasis between squamous cell carcinoma and adenocarcinoma of the uterine cervix

OBJECTIVE: The purpose of our study was to investigate a possible difference in ovarian metastasis between squamous cell carcinoma and adenocarcinoma of the uterine cervix and to confirm clinicopathological variables associated with the metastases. METHODS: Clinical and pathological variables of 1064 patients with invasive squamous cell carcinoma and 240 with adenocarcinoma were studied. RESULTS: Ovarian metastasis was found in 14 patients (1.3%) with squamous cell carcinoma and 15 (6.3%) with adenocarcinoma. The mean age of patients with ovarian metastasis of squamous cell carcinoma was 57.4 years, compared to 50.2 years for adenocarcinoma. Ovarian metastasis of adenocarcinoma was more likely to be visible (40.0%) and present in both ovaries (66.7%), while these two characteristics occurred in only 21.4 and 36.7% of patients with squamous cell carcinoma. A logistic regression analysis with clinical variables indicated that clinical stage beyond IIb was a significant variable of squamous cell carcinoma, and more than 30-mm tumor size was significant in adenocarcinoma. CONCLUSION: The incidence of ovarian metastasis of adenocarcinoma of the uterine cervix was significantly higher than that of squamous cell carcinoma. The incidence of adenocarcinoma was associated more closely with tumor size than clinical stage, whereas it was more associated with clinical stage in squamous cell carcinoma. The results thus suggested that the differences in ovarian metastases were caused by the different characteristics of the two types of carcinoma.     

Gross omental metastasis of mucoepidermoid carcinoma of the uterine cervix: A case report

Reich O, Tamussino K. Gross omental metastasis of mucoepidermoid carcinoma of the uterine cervix: A case report. Int J Gynecol Cancer 1998; 8 : 349–351.
A 54-year-old female with invasive mucoepidermoid carcinoma (MEC) of the uterine cervix had an uncommon type of spread. On clinical examination the patient had FIGO stage IIB disease; MRI showed a tumor volume of 15 ml and extension to right parametrium. Radical hysterectomy was planned but laparotomy revealed gross extrapelvic metastases in the greater omentum. The unexpected spread of this tumor may suggest that MECs of the cervix are more aggressive than their squamous cell counterparts.     

Squamous cell carcinoma of the uterine cervix in association with stage 0 chronic lymphocytic leukemia/small lymphocytic lymphoma

BACKGROUND: There have been many cases of multiple malignant neoplasms involving the female genital tract reported, but involvement by epithelial and hematologic malignancy is extremely rare. CASE: A 52-year-old woman, who was followed for stage 0 chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), had developed invasive squamous cell carcinoma of the uterine cervix. Microscopic examination of the hysterectomy specimen disclosed invasive squamous cell carcinoma in the cervix and monotonous populations of small lymphoid cells with proliferation centers, which are consistent with CLL/SLL, in the cervix as well as parametrium. Thirty months after the initial diagnosis of CLL/SLL, the patient died with systemic dissemination of squamous cell carcinoma, but the CLL/SLL remained a local disease. CONCLUSION: The clinical course of squamous cell carcinoma in this case appeared to be aggressive, but it was unclear whether the outcome was associated with an altered immune status due to the presence of concurrent CLL/SLL.     

Synchronous invasive squamous cell carcinoma and clear cell adenocarcinoma of the uterine cervix: a different human papillomavirus status

BACKGROUND: A multiple primary invasive carcinoma of the cervix is a rare condition and is seldom composed of squamous cell carcinoma and clear cell adenocarcinoma. CASE: A 47-year-old woman presented with contact bleeding. The anterior lip of the cervix revealed a 2.0-cm protruded mass. Preoperative pathological and imaging studies demonstrated the squamous cell carcinoma of the exocervix alone. Radical hysterectomy was performed on the diagnosis of stage 1B cervical cancer. Histological examination of the specimen manifested a coexisting invasive clear cell adenocarcinoma in the endocervix. Human papillomavirus (HPV) 18 was detected in the squamous cell carcinoma; however, no HPV was detected in the clear cell adenocarcinoma. CONCLUSION: This finding suggests that there was an obvious difference in association of HPV with the two neoplasms.     

Lymphoepithelial-like carcinoma of the uterine cervix; a case report

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare variant of squamous cell carcinoma of the uterine cervix. This tumor is characterized by nests of poorly differentiated epithelial cells surrounded by a prominent lymphocytic infiltration. Despite the poorly differentiated pathological findings, it appears to have a better outcome than the usual squamous cell carcinoma of the uterine cervix. Therefore, it is quite important to differentiate this tumor from poorly differentiated squamous cell carcinoma and lympho-proliferative disorders of the cervix. LELC arising from the nasopharynx has been suggested to be associated with Epstein-Barr virus (EBV), whereas the involvement of EBV in LELC of the uterine cervix is still controversial. In addition, the role of high-risk human papilloma virus (HPV) in this type of tumor remains unknown. We report a case of LELC of the cervix with diagnosis on the basis of histopathology in a 52-year-old Japanese woman who presented with a history of continuous bleeding post menopause. We also examine the association of EBV and HPV in this case.     

Extensive subcutaneous metastases from squamous cell carcinoma of the cervix in patient with HIV

Abstract. Amit A, Edwards CL, Athey P, Kaplan AL. Extensive subcutaneous metastases from squamous cell carcinoma of the cervix in patient with HIV.
Advanced human immunodeficiency viral disease is associated with a high prevalence of cervical squamous intraepithelial and invasive lesions and probably with a rapidly progressive course of disease. Metastases to the skin occur rarely in cervical cancer, even in terminal stage of the disease. A patient with human immunodeficiency virus (HIV) for 14 years was diagnosed with squamous cell cancer of the cervix, Stage I-B2 in June 1997. She underwent successful radiotherapy. She then presented in January 1999 with recurrence evidenced by extensive subcutaneous nodules and multiple metastases. The patient developed rapidly progressive disease and died within two months. Patients with HIV and cervical cancer may present with a more aggressive course of disease. Aggressive treatment and closer follow-up may be indicated.     

宫颈鳞癌和上皮内瘤变组织中TRF1、TRF2及HPV16、HPV18的检测及其意义

目的研究端粒结合蛋白TRF1、TRF2在宫颈鳞癌发生发展中的作用并分析HPV16、HPV18感染与TRF1、TRF2蛋白表达的关系。方法随机选择南华大学附属第一医院病理科2005年9月至2006年10月期间的组织石蜡块标本共86例,采用原位杂交方法检测HPV16、HPV18在15例正常宫颈上皮、36例宫颈上皮内瘤变(CIN)和35例宫颈鳞癌组织中的感染情况;采用免疫组化方法检测所有组织标本中TRF1、TRF2蛋白的表达。结果(1)HPV16、HPV18阳性感染率CIN组[63.9%(23/36)]和宫颈鳞癌组[97.1%(34/35)]显著高于正常组[20.0%(3/15)](χ2=30.639,P<0.01)。(2)TRF1阳性表达率宫颈鳞癌组[40.0%(14/35)]显著低于CIN组[63.9%(23/36)]和正常组[86.7%(13/15)](χ2=10.237,P<0.01);CINⅢ组[42.9%(6/14)]显著低于CINⅠ组[90.0(9/10)](χ2=5.531,P<0.01)。TRF2阳性表达率宫颈鳞癌组[80.0%(28/35)]显著高于CIN组[52.8%(19/36)]和正常组[...     

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.     

Does adenocarcinoma of uterine cervix have a worse prognosis than squamous carcinoma?

OBJECTIVE: The objective of this study was to examine the influence of histology on the outcome of patients with cervix carcinoma, treated with radiotherapy and radical surgery. PATIENTS AND METHODS: Clinical, histological, therapeutical and outcome data of 360 patients with stage IB-II cervix carcinoma patients (45 adenocarcinomas and 315 squamous cell carcinoma) managed between 1985 and 1998 were collected from the database of the Institut Gustave-Roussy. RESULTS: The incidence of adenocarcinomas slightly increased during the study period (P =0.07). Histological grade was higher for squamous cell carcinoma than for adenocarcinoma (P =0.08). Adenocarcinomas were smaller than squamous cell carcinoma (P =0.06). With only 38% of sterilized hysterectomy specimen vs 52% for squamous cell carcinomas (P =0.07), adenocarcinoma seemed to be less radiosensitive. With a median follow-up of 67 months, histological type did not influence survival. DISCUSSION AND CONCLUSIONS: Our study demonstrates that radiosensitivity is different between adenocarcinoma and squamous cell carcinoma of the cervix and that surgery may compensate the low radiosensitivity of adenocarcinoma.