Microinvasive adenocarcinoma of the cervix: A clinicopathologic study of 77 women

Objective

To prove that microinvasive adenocarcinoma of the cervix exists and, like its squamous counterpart, carries an excellent prognosis.

Methods

Seventy-seven women with microinvasive adenocarcinoma of the cervix were seen from 1971 to 1995. Microinvasion was defined as depth of invasion or tumor thickness of at most 5 mm. Microscopic assessment was made on punch biopsies, serially sectioned conization specimens, and extensively sampled hysterectomy specimens.

Results

Most of the women had abnormal Papanicolaou smears. We made definitive diagnoses on conization specimens in 49 women, hysterectomy specimens in 22, and colposcopically directed punch biopsies in six (there being no residual disease in the subsequent conizationhysterectomy specimens). The length of microinvasive adenocarcinomas ranged from 0.8 to 21 mm, and the volume was between 3 and 1000 mm.³ The tumors were multicentric in 21 cases, but no true “skip” lesions were found. Overall, 58 cold-knife conizations were performed: the margins were free in 39 cases, involved in 18, and inconclusive in one. The one loop conization had involved margins. Definitive therapy included cold-knife conization in 16 women, combined with pelvic-node dissection in four. In the remainder of the women, we performed some type of hysterectomy. None of the 26 women who had radical hysterectomy had parametrial spread, and none of the 48 who had pelvic-node dissection or the 23 in whom one or both adnexa were removed had metastases. There have been two “recurrences” to date; one was an adenocarcinoma and the other a squamous cell carcinoma, both at the vault.

Conclusion

Microinvasive adenocarcinoma of the cervix is a clinicopathologic entity that appears to have the same prognosis, and should be treated in the same way, as its squamous counterpart.