Lymphoma of uterine cervix

Two patients with malignant lymphoma of the cervix treated with radiotherapy and chemotherapy are reported. Both are alive and disease-free 8 years later. The literature is reviewed to define the role of the different treatment modalities.     

Adenocarcinoma of the uterine cervix

The prognosis of 589 patients with adenocarcinoma, 387 with mixed type of adenocarcinoma and squamous cell carcinoma of the uterine cervix from 18 hospitals in Japan were evaluated. Stage 0, I a patients with adenocarcinoma or mixed type had good survival. Stage I b, II, III patients had smaller five-year survival (p less than 0.01) than squamous cell carcinoma. Lymph nodes metastasis was related to poorer survival. Radiation therapy or chemotherapy was not sufficient for patients with stage I b, II, III, IV diseases.     

Adenocarcinoma of the uterine cervix

In Finland, the incidence of cervical cancer has shown a decreasing tendency since the 1960s. The same trend, however, has not been noticed in the incidence of cervical adenocarcinoma. The reason for this is not known, although many studies have shown differences in the cause, epidemiology, and biology of the epidermoid and adenocarcinoma of the uterine cervix. A total of 106 new patients with cervical adenocarcinoma were treated at our institution from 1976 to 1980, which represents 20.4% of all cervical carcinomas treated. The mean age of the patients was 58.1 years (range, 29 to 82 years) and the peak incidence was in the group 60 to 69 years of age. Most of the patients were postmenopausal (71.7%) and the main symptom was abnormal vaginal bleeding (78.3%). The proportion of Stage I was 61.3%. Combined operative and radiation therapy was used in 74.5% of the patients. The overall 5-year survival rate was 65.1% (corrected 74.5%), which did not differ from that of patients with squamous cell carcinoma. The most significant prognostic factors were the size of the tumor, presence of pelvic lymph node metastases, and the stage of the disease.     

Adenocarcinoma of the uterine cervix

Between 1958 and 1969, 251 patients were treated at Radiumhemmet in Stockholm for adenocarcinoma of the uterine cervix. The histologic specimens were reevaluated. In the 211 cases of pure adenocarcinoma, the 5-year survival rate was compared with that in the total of cervical epithelial malignancies. The rate was lower in the adenocarcinoma cases, with respective crude 5-year survival rates of 84%, 50%, and 9% in Stages I, II, and III. Two modes of treatment, irradiation alone or irradiation plus radical surgery, were used in Stages IB and IIA. The combined treatment gave significantly improved 5-year survival rates.     

Adenocarcinoma of the uterine cervix

Fifty patients with adenocarcinoma of the uterine cervix were evaluated retrospectively. Treatment was based on the stage and size of tumors and the overall medical condition of the patient. Radical surgery or surgery in combination with radiation therapy was employed whenever possible. The overall survival rate was 50%, with Stage IB survival 74%. Survival in Stage IB patients was adversely affected by increasing tumor grade and size. This closely correlated with a tendency of the tumors to dedifferentiate as they increased in size. Lymph node involvement increased with increasing grade of tumor as well. Survival in patients with advanced disease was dismal. Survival increased with aggressive management which should, if possible, include surgery in Stage I and II disease.     

Radiotherapy of uterine cervix carcinoma

Seventy-eight patients with uterine cervix cancer were treated radically with standardized radiation therapy at Teikyo University Hospital in Tokyo from January 1979 to December 1985. The age of these patients ranged from 32 to 88 years old (average age 66.0). The pathology and the stage of them were 71 cases of squamous cell carcinoma (1 in stage I, 11 in stage II, 58 in stage III and 1 in stage IV) and 7 cases of adenocarcinoma (6 in stage III and 1 in stage IV). The cumulative survival rates for 5 years by Kaplan-Meier method were 71.5% for squamous cell carcinoma stage II, 47.4% for squamous cell carcinoma stage III and 0% for adenocarcinoma stage III. Radiation injury was studied by the grading system of Kottmeier-NIRS in Japan. The incidence of the injuries for grade 2 and 3 was 12.8% (10/78), and the items of those were rectal injury 5.1% (4/78) and sigmoidal colonic injury 7.7% (6/78). The results of survival rate were fair for the squamous cell carcinoma compared with the other reports but poor for adenocarcinoma stage III. Concerning the therapy for advanced adenocarcinoma of the uterine cervix, special consideration should be given for irradiation doses or infusion chemotherapy.     

Precancerous lesions of the uterine cervix

The presence of mucous and non-pathologic elements liable to hamper analysis of the smear is one of the main problems in ploidy assessment of precancerous cervical lesions. For our study, we employed a sampling system guided by microcolpohysteroscopy, which we used to identify the pathologic zone and select the morphologically altered elements only. Fifty-five cervical lesions and 6 negative controls were analyzed. All controls and 24 lesions were diploid, 15 polyploid and 16 aneuploid. All but one aneuploid lesions had a histological diagnosis of GIN. We failed to observe any significant difference in the aneuploid percentage of high and low grade lesions while diploid cases decreased in proportion to the severity of the lesion. The samples obtained had the advantage of being representative, technically valid and at the same time extremely suitable for an automated image analysis of ploidy. Thus this new sampling method could be extensively used.     

Malignant lymphoma of the uterine cervix

Three patients with primary malignant lymphoma of the uterine cervix are reported and the literature is reviewed. All of the patients in the current cases presented with irregular menstruation. Two patients were found to have diffuse histiocytic lymphoma, and one patient had diffuse mixed lymphoma. Histologic diagnosis was confirmed by outside expert pathologists in all cases. In spite of locally advanced disease according to FIGO's classification (Stage IVA-2 and Stage IIB-1), they responded well to external irradiation, and had control of tumor within the pelvis. All are alive at 13, 7, and 3 years, respectively, after the completion of irradiation. One patient developed disseminated disease 4.25 years after the completion of external irradiation, but was successfully treated with combination chemotherapy for 2 years, and is alive at 6.75 years after the completion of chemotherapy without disease. Review of the other 21 cases reported in the literature reveals that 14 were free of disease after treatment. The importance of distinguishing malignant lymphoma from undifferentiated carcinoma or sarcoma is emphasized since cervical malignant lymphoma can be successfully treated with irradiation in spite of locally advanced disease.     

Embryonal rhabdomyosarcoma of the uterine cervix

Introduction  Embryonal rhabdomyosarcoma (RMS) of the uterine cervix is a rare and extremely malignant entity. Generally, embryonal RMS originating in the uterine cervix is usually diagnosed in adolescence. Before the introduction of effective adjuvant chemotherapy, the prognosis of these lesions was poor. We have treated a young woman suffering from this disease using a combination of surgery, chemotherapy and radiation therapy (RT) with excellent results. The medical community should keep in mind that embryonal RMS of the uterine cervix, despite its malignancy and rarity, can be cured if adequate treatment is given. Case  A case of a young woman aged 20, presenting with vaginal bleeding, is reported. The histological examination revealed embryonal RMS of uterine cervix. The patient was treated with a combination of surgery, chemotherapy and RT. A review in the literature, which is also presented, shows that the combined treatment of embryonal RMS using surgery and multidrug chemotherapy has significantly improved survival. Conclusion  Patients with favourable prognostic parameters, such as localised disease without deep myometrial invasion, single polyp and embryonal histologic subtype, can effectively be treated by surgery. Patients with unfavourable prognostic parameters seem to benefit from a multimodality approach including surgery, adjuvant chemotherapy and RT.