Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

Francesco Sopracordevole,Andrea Ciavattini,Diego Rossi,Monica Buttignol,Marta Angelini,Jacopo Di Giuseppe,Pierino Boschian-Bailo

doi:10.1155/2014/296253

Abstract

Microinvasive adenocarcinoma (MIAC) of the uterine cervix is rare in pregnancy. Published data on conservative treatment of MIAC both in pregnant and nonpregnant women are scarce. A conservatively treated case of MIAC in a 13-week-pregnant woman after a diagnosis of atypical glandular cells (AGC) on pap smear at the 6th week of pregnancy is presented. The problems of suspected adenocarcinoma in situ (AIS) on biopsy and MIAC on cone biopsy in pregnancy, as well as the risks and benefits of a conservative treatment are discussed. After colposcopic guide laser cervical conization and expression of informed consent the patient underwent followup and vaginal delivery at 40 weeks plus 3 days of gestation. In this case, no obstetric complication has been recorded after the cervical conization, and after a followup of 18 months the patient was alive and free of disease, with negative results as far as pap smear, colposcopy, HPV status, and cervical curettage are concerned. In a stage Ia1 disease of endocervical type, with clear margins and without lymph-vascular space invasion, cervical conization performed during the second trimester may be considered a definitive and safe treatment, at least up to delivery, after expression of informed consent by the woman.

Highlights

Microinvasive adenocarcinoma of the cervix (MIAC) is occasionally found in the definitive histology in the specimens of conization performed because of squamous or glandular intraepithelial cervical neoplasia or suspicious for adenocarcinoma in situ (AIS)
The conservative treatment of microinvasive cancers (MISC) [10, 11] and small stage IB1 squamous cancer during pregnancy [12, 13] seems to be safe, scarce data are available for MIAC conservative treatment in pregnancy [2]
After 24 weeks from delivery, the patient expressed her desire for another child and signed her informed consent to consider the conization performed during pregnancy as definitive treatment, at least up to a pregnancy

Summary

Introduction

Microinvasive adenocarcinoma of the cervix (MIAC) is occasionally found in the definitive histology in the specimens of conization performed because of squamous or glandular intraepithelial cervical neoplasia or suspicious for adenocarcinoma in situ (AIS). The conservative treatment of MISC [10, 11] and small stage IB1 squamous cancer during pregnancy [12, 13] seems to be safe, scarce data are available for MIAC conservative treatment in pregnancy [2]. This case report is an addition to the few published cases of conservatively treated MIACs during pregnancy

Case Presentation

Discussion

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Conclusions

Conflict of Interests