Unexpected tumor progression after conization for carcinoma in situ of the uterine cervix

• Published in: The journal of obstetrics and gynaecology research 2012-01, Vol.38 (1), p.84-88
• Main Authors: Omatsu, Kohei, Takeshima, Nobuhiro, Matoda, Maki, Nomura, Hidetaka, Umayahara, Kenji, Sugiyama, Yuko, Utsugi, Kuniko, Tanaka, Hiroko, Akiyama, Futoshi, Takizawa, Ken
• Format: Article
• Language: English
• Subjects: Adult; Bone imaging; carcinoma in situ; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Cervical cancer; Cervical carcinoma; Cervix; Cervix Uteri - pathology; Cervix Uteri - surgery; Chemotherapy; Conization; Electrosurgery; Endometrium; Female; Humans; Hysterectomy; loop electrosurgical excision procedure; Lymph nodes; Magnetic resonance imaging; Metastases; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Patients; Retrospective Studies; Tumors; unexpected tumor progression; uterine cervical cancer; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Uterus; Vagina
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/j.1447-0756.2011.01632.x

Aim:  To determine the safety and usefulness of conization with an electrosurgical loop (the loop electrosurgical excision procedure [LEEP]) in young women with carcinoma in situ (CIS) of the uterine cervix. Methods:  A retrospective medical chart review of five patients with CIS initially treated with LEEP conization between 2002 and 2010 and who later experienced recurrence in the form of invasive or advanced disease was conducted. Results:  The median patient age at initial LEEP conization was 41 years (33–56 years). The margin status in conization specimens was positive in three of the five patients. The median time to detection of tumor progression was 50 months (17–58 months). Magnetic resonance imaging was effective in detecting tumor recurrence in all cases. In four patients, hysterectomy was performed to treat the recurrence; these four patients are currently alive and disease‐free. One patient with cervical lymph nodes and bone metastases was treated with chemotherapy alone; however, the patient died. In surgical specimens, tumor progression was observed extending toward the endometrium in all five patients and toward the vagina in two patients. Conclusion:  This study indicates that patients with CIS occasionally show unexpected tumor progression after conization and the progression could be life‐threatening. Recurrent disease often shows tumor progression toward the endometrium or vagina, leading to difficulties in its detection at periodic pelvic examinations.