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Conservative treatment of coexisting microinvasive squamous and adenocarcinoma of the cervix: report of two cases and literature review

Authors Sopracordevole F, Di Giuseppe J, Cervo S, Buttignol M, Giorda G, Ciavattini A, Canzonieri V

Received 6 August 2015

Accepted for publication 25 November 2015

Published 27 January 2016 Volume 2016:9 Pages 539—544


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ram Prasad

Peer reviewer comments 2

Editor who approved publication: Professor Daniele Santini

Francesco Sopracordevole,1,* Jacopo Di Giuseppe,2,* Silvia Cervo,3,4 Monica Buttignol,1 Giorgio Giorda,1 Andrea Ciavattini,2 Vincenzo Canzonieri3,5

1Gynecologic Oncology Unit, Department of Surgical Oncology, CRO Aviano National Cancer Institute, Aviano, Pordenone, 2Woman’s Health Sciences Department, Gynaecologic Section, Polytechnic University of Marche, Ancona, 3CRO-Biobank, 4Clinical Cancer Pathology, 5Pathology Unit, CRO Aviano National Cancer Institute, Aviano, Pordenone, Italy

*These authors contributed equally to this work

Abstract: Coexistence of microinvasive squamous cell carcinoma (MISCC) and microinvasive adenocarcinoma (MIAC) of the cervix is a rare phenomenon with very few clinically significant cases described in the literature. While a conservative approach has been studied, and may be effective in MISCC, a lower number of studies that recommend conservative treatment are available for MIAC. We report two cases of synchronous cervix lesions in two separate foci, MISCC and MIAC, who underwent fertility-sparing treatment with long-term follow-up. We describe clinical, histological, and immunohistochemical features of the two cases. The first case is a 41-year-old female with a diagnosis of MIAC of endocervical type, grade 1 differentiation, with a stromal invasion, associated with a separate area of squamous cell carcinoma (International Federation of Gynecology and Obstetrics/TNM stage: pT1a1G1). The second case is a 45-year-old female with a diagnosis of plurifocal MISCC, associated with an MIAC of endocervical type with a stromal invasion (International Federation of Gynecology and Obstetrics/TNM stage: pT1a1G1). After multidisciplinary counseling, both patients accepted conization as definitive treatment. Eleven years after the conization, all tests (Papanicolaou smear, colposcopy, cervical curettage, and hybrid capture 2-human papillomavirus test) planned quarterly in the first year and every 6 months in the subsequent years were negative in both patients. In women affected by stage IA1 squamous cervical cancer coexisting with stage IA1 adenocarcinoma endocervical type, with clear margins, and without lymphovascular space invasion, cervical conization may be considered a fertility-preserving, safe, and definitive therapeutic option.

Keywords: cervical conization, cervical lesions, FIGO stage, microinvasive adenocarcinoma, microinvasive squamous cell carcinoma, uterine cervical neoplasms

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