ENDO Messages for November, 2007: Re: Surgical Pathology Report

Re: Surgical Pathology Report

From: Sarah (anonymous@obgyn.net)
Wed Nov 28 16:54:32 2007

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Abstract The clinico-pathologic details of 200 patients with micro-invasive squamous-cell carcinoma of the cervix have been analyzed. All tumors invaded 5 mm or less below the basement membrane. One hundred and nine were categorized as FIGO stage 1a1 (early stromal invasion) and 91 as FIGO stage 1a2 (micro-carcinoma). The horizontal spread (length) of 12 micro-carcinomas exceeded 7 mm. Twenty-three had stromal invasion 3 mm or more, and 22 had capillary-like space involvement. Fifty-eight patients underwent pelvic lymphadenectomy in addition to hysterectomy and none had positive nodes. Univariate and multivariate analyses of possible prognostic factors including depth, horizontal spread, width, area, volume, grade, growth pattern, capillary-like space involvement, and stromal reaction failed to show any to be significantly associated with recurrence. The median duration of follow-up is now 8 years (0–22 years). Despite complete resection, seven (3.5%) patients developed recurrence of in situ or invasive carcinoma (three after early stromal invasion and four after micro-carcinoma), all of which were located at the vaginal vault. There were two deaths, one due to pulmonary squamous-cell carcinomatosis 21 years after early stromal invasion, the connection being tenuous, and the other due to local recurrence. There have been no recurrences to date in 23 patients treated by conization alone. The uniformly good prognosis of patients in this study is attributed to meticulous sampling of operative specimens resulting in accurate diagnosis and appropriate treatment, which may be conization alone provided the margins are free, there is no capillary-like space involvement, and the depth of penetration is less than 3 mm.

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At Wed, 28 Nov 2007, anonymous wrote: >
>My doctor recently called me to alert me of my pathology report from a
>recent LEEP procedure and I have been referred to a specialist. I have
>a copy of the pathology report and am trying to understand what it
>means. I have done a ton of research and think I understand the
>important questions I need to make sure to ask the specialist, but am
>looking for any additional insight into the findings because they sound
>alarming. Here are my results:
>
>"Endocervix, Leep Excisiion: INVASIVE MODERATE TO POORLY DIFFERENTIATED
>SQUAMOUS CELL CARCINOMA ARISING IN EXTENSIVE SQUAMOUS CELL CARCINOMA IN
>SITU. INVASIVE CARCINOMA AND CARCINOMA IN SITU EXTENSIVELY EXTEND TO
>CAUTERY.
>
>ENDOCERVIX, CURETTAGE: EXTENSIVE SQUAMOUS CELL CARCINOMA IN SITU WITH
>FOCI SUSPICIOUS FOR INVASIVE CARCINOMA.
>
>THE INVASIVE COMPONENT IS PRESENT ON MULTIPLE FRAGMENTS, MULTIFOCALLY
>EXTENDS TO CAUTERIZED MARGINS AND IS PROBABLY MACROINVASIVE (GREATER
>THAN pT1a)."

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