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Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix.

Nagura M, Koshiyama M, Matsumura N, Kido A, Baba T, Abiko K, Hamanishi J, Yamaguchi K, Mikami Y, Konishi I - BMC Cancer (2014)

Bottom Line: In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.MRI can be used to detect preinvasive and microinvasive disease before surgery.It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. koshiyamam@nifty.com.

ABSTRACT

Background: Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior.

Methods: We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis.

Results: Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.

Conclusions: MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

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A representative false PSCC case (Patient No. 19). a. Several small crowds of malignant cells appeared PSCC-like on the colposcopic selective biopsy in Patient No. 19. b. Patient No.19 had a 13-mm-sized invasive lesion on the anterior lip of the cervix (T2-weighted sagittal MRI). c. The surgical specimen of Patient No. 19 showed destructive invasion extending to deep stroma with lymphovascular space invasion, which was predominant over the papilla-like exophytic growth (H and E, 20 X). Consequentially, we obtained a diagnosis of non-keratinizing SCC.
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Fig2: A representative false PSCC case (Patient No. 19). a. Several small crowds of malignant cells appeared PSCC-like on the colposcopic selective biopsy in Patient No. 19. b. Patient No.19 had a 13-mm-sized invasive lesion on the anterior lip of the cervix (T2-weighted sagittal MRI). c. The surgical specimen of Patient No. 19 showed destructive invasion extending to deep stroma with lymphovascular space invasion, which was predominant over the papilla-like exophytic growth (H and E, 20 X). Consequentially, we obtained a diagnosis of non-keratinizing SCC.

Mentions: The clinical features of the 16 false PSCC patients are summarized in Additional file 2: Table S2. The mean age of these 16 patients was 51.8 years, with a range of 34 to 68 years. There was one (6%) patient with stage IA2 disease, six (38%) patients with stage IB1 disease, three (19%) patients with stage IB2 disease, one (6%) patient with stage IIA1 disease and five (31%) patients with stage IIB disease. A representative false PSCC case (Patient No.19) is presented in Figure 2a-c. Histologically, two cases were diagnosed as microinvasive SCC, 13 cases were diagnosed as non-keratinizing SCC, and one case was diagnosed as adenosquamous carcinoma based on the results of the surgical specimens. Twelve (75%) of the 16 false PSCC patients were alive at the time of the last contact, with no episodes of recurrence over a mean follow-up of 50 months (range: 17 to 120 months). However, four (25%) of the 16 false PSCC patients (at stage IB2, IB2, IIB and IIB) developed recurrence, and three (19%) patients (at stage IB2, IB2 and IIB) died.


Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix.

Nagura M, Koshiyama M, Matsumura N, Kido A, Baba T, Abiko K, Hamanishi J, Yamaguchi K, Mikami Y, Konishi I - BMC Cancer (2014)

A representative false PSCC case (Patient No. 19). a. Several small crowds of malignant cells appeared PSCC-like on the colposcopic selective biopsy in Patient No. 19. b. Patient No.19 had a 13-mm-sized invasive lesion on the anterior lip of the cervix (T2-weighted sagittal MRI). c. The surgical specimen of Patient No. 19 showed destructive invasion extending to deep stroma with lymphovascular space invasion, which was predominant over the papilla-like exophytic growth (H and E, 20 X). Consequentially, we obtained a diagnosis of non-keratinizing SCC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232646&req=5

Fig2: A representative false PSCC case (Patient No. 19). a. Several small crowds of malignant cells appeared PSCC-like on the colposcopic selective biopsy in Patient No. 19. b. Patient No.19 had a 13-mm-sized invasive lesion on the anterior lip of the cervix (T2-weighted sagittal MRI). c. The surgical specimen of Patient No. 19 showed destructive invasion extending to deep stroma with lymphovascular space invasion, which was predominant over the papilla-like exophytic growth (H and E, 20 X). Consequentially, we obtained a diagnosis of non-keratinizing SCC.
Mentions: The clinical features of the 16 false PSCC patients are summarized in Additional file 2: Table S2. The mean age of these 16 patients was 51.8 years, with a range of 34 to 68 years. There was one (6%) patient with stage IA2 disease, six (38%) patients with stage IB1 disease, three (19%) patients with stage IB2 disease, one (6%) patient with stage IIA1 disease and five (31%) patients with stage IIB disease. A representative false PSCC case (Patient No.19) is presented in Figure 2a-c. Histologically, two cases were diagnosed as microinvasive SCC, 13 cases were diagnosed as non-keratinizing SCC, and one case was diagnosed as adenosquamous carcinoma based on the results of the surgical specimens. Twelve (75%) of the 16 false PSCC patients were alive at the time of the last contact, with no episodes of recurrence over a mean follow-up of 50 months (range: 17 to 120 months). However, four (25%) of the 16 false PSCC patients (at stage IB2, IB2, IIB and IIB) developed recurrence, and three (19%) patients (at stage IB2, IB2 and IIB) died.

Bottom Line: In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.MRI can be used to detect preinvasive and microinvasive disease before surgery.It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. koshiyamam@nifty.com.

ABSTRACT

Background: Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior.

Methods: We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis.

Results: Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.

Conclusions: MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

Show MeSH
Related in: MedlinePlus