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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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The relationship between the MRI findings before surgery and the final depth of tumor invasion. a. Patient No.6. On T2-weighted sagittal images, a small mass of high intensity grew on the anterior lip of the uterine cervix superficially. The stromal tissue was not torn by a tumor. In this case, the depth of invasion was 1.8 mm on the surgical specimen. b. Patient No. 8. On T2-weighted sagittal images, a flat tumor grew on the posterior lip of the cervix. The low intensity of cervical stroma was somewhat irregular. We diagnosed the lesion as invasive carcinoma. In this case, a depth of invasion was 3.1 mm on the surgical specimen. c. Patients No. 9. On T2-weigted sagittal images, the papillary tumor was detected on the cervical os. The stroma of the anterior and posterior lips was torn by a tumor. In this case, the depth of invasion was 9 mm on the surgical specimen.
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Fig5: The relationship between the MRI findings before surgery and the final depth of tumor invasion. a. Patient No.6. On T2-weighted sagittal images, a small mass of high intensity grew on the anterior lip of the uterine cervix superficially. The stromal tissue was not torn by a tumor. In this case, the depth of invasion was 1.8 mm on the surgical specimen. b. Patient No. 8. On T2-weighted sagittal images, a flat tumor grew on the posterior lip of the cervix. The low intensity of cervical stroma was somewhat irregular. We diagnosed the lesion as invasive carcinoma. In this case, a depth of invasion was 3.1 mm on the surgical specimen. c. Patients No. 9. On T2-weigted sagittal images, the papillary tumor was detected on the cervical os. The stroma of the anterior and posterior lips was torn by a tumor. In this case, the depth of invasion was 9 mm on the surgical specimen.

Mentions: MRI generally revealed significant stromal invasion of PSCC, if present. Seven (58%) patients exhibited no apparent masses or stromal invasion of PSCC on MRI before surgery (Additional file 3: Table S4). Three of seven patients actually displayed no stromal invasion on the surgical specimens. These seven cases ultimately involved stromal invasion with a depth ranging from 0 to 3 mm. However, the remaining five (42%) cases in which MRI demonstrated stromal invasion involved microscopic invasion ranging from 3.1 to 35 mm in depth. The two groups in which invasion was or was not detected on MRI did not overlap (Figure 4b). In this study, the border depth of microscopic invasion was approximately 3 mm, which was used to predict stromal invasion on MRI before surgery (Figure 5a-c).Figure 5


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)

The relationship between the MRI findings before surgery and the final depth of tumor invasion. a. Patient No.6. On T2-weighted sagittal images, a small mass of high intensity grew on the anterior lip of the uterine cervix superficially. The stromal tissue was not torn by a tumor. In this case, the depth of invasion was 1.8 mm on the surgical specimen. b. Patient No. 8. On T2-weighted sagittal images, a flat tumor grew on the posterior lip of the cervix. The low intensity of cervical stroma was somewhat irregular. We diagnosed the lesion as invasive carcinoma. In this case, a depth of invasion was 3.1 mm on the surgical specimen. c. Patients No. 9. On T2-weigted sagittal images, the papillary tumor was detected on the cervical os. The stroma of the anterior and posterior lips was torn by a tumor. In this case, the depth of invasion was 9 mm on the surgical specimen.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: The relationship between the MRI findings before surgery and the final depth of tumor invasion. a. Patient No.6. On T2-weighted sagittal images, a small mass of high intensity grew on the anterior lip of the uterine cervix superficially. The stromal tissue was not torn by a tumor. In this case, the depth of invasion was 1.8 mm on the surgical specimen. b. Patient No. 8. On T2-weighted sagittal images, a flat tumor grew on the posterior lip of the cervix. The low intensity of cervical stroma was somewhat irregular. We diagnosed the lesion as invasive carcinoma. In this case, a depth of invasion was 3.1 mm on the surgical specimen. c. Patients No. 9. On T2-weigted sagittal images, the papillary tumor was detected on the cervical os. The stroma of the anterior and posterior lips was torn by a tumor. In this case, the depth of invasion was 9 mm on the surgical specimen.
Mentions: MRI generally revealed significant stromal invasion of PSCC, if present. Seven (58%) patients exhibited no apparent masses or stromal invasion of PSCC on MRI before surgery (Additional file 3: Table S4). Three of seven patients actually displayed no stromal invasion on the surgical specimens. These seven cases ultimately involved stromal invasion with a depth ranging from 0 to 3 mm. However, the remaining five (42%) cases in which MRI demonstrated stromal invasion involved microscopic invasion ranging from 3.1 to 35 mm in depth. The two groups in which invasion was or was not detected on MRI did not overlap (Figure 4b). In this study, the border depth of microscopic invasion was approximately 3 mm, which was used to predict stromal invasion on MRI before surgery (Figure 5a-c).Figure 5

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