Capillary-like Space Involvement Research Articles

Zervixkarzinom in der Schwangerschaft und bei Nicht-Graviden: Langzeitprognose im Vergleich

Purpose: To evaluate the prognosis of patients with invasive cervical cancer related to pregnancy and to assess if survival is altered by pregnancy. Methods : We reviewed 20 patients (mean age 34.7 years) with invasive cervical carcinoma diagnosed during pregnancy between 1971 and 1995.This group was compared with 541 non-pregnant controls with invasive cervical cancer. All patients had had radical surgical treatment. Results: The overall (disease-free) 5year survival rates of the pregnant and non-pregnant patients were 74.4% (6/20 died of disease) and 78.2% (128/541), respectively (p=0.58). The survival rate of a matched group of non-pregnant patients younger than 44 years was 74.8% (57/220) (p = 0.77). Four of the pregnant patients had FIGO stage IA2,11 stage IB, 1 stage IIA, 3 stage IIB, 1 stage Illb disease. All 4 pregnant patients with stage IA2 disease survived free of recurrence. The 5-year survival rate of the 11 pregnant patients with stage IB did not differ from that of the non-pregnant patients (81.8% [2/11] versus 78.9% [28/126], p=0.65). The pregnant patients with stage II and III disease had a 5-year survival rate of 40% (4/5) and differed from the non-pregnant patients with 69% (66/94) (p = 0.0027). The 5-year survival rates of pregnant and non-pregnant patients with negative lymph nodes were 77.8% (2/9) and 83.6% (25/146), respectively (p=0.74). The 5-year survival rates of pregnant and non-pregnant patients with positive lymph nodes were 53.6% (4/7) and 56.5% (32/74), respectively (p = 0.53). There were no differences in survival rates between pregnant and non-pregnant patients according to squamous cell versus adenocarcinoma and capillary-like space involvement. 4 pregnant patients with stage IB delayed therapy for 13 to 26 weeks and survived free of disease. Only 10 of 15 pregnant patients treated immediately after diagnosis survived. Conclusions: Our data do not suggest that pregnancy has an adverse effect on the prognosis of patients with invasive cervical carcinoma. Delaying treatment until the fetus has achieved lung maturity appears to be a possible option for patients with stage I disease.

Micro-invasive squamous cell carcinoma of the cervix: a clinico-pathologic study of 200 cases with long-term follow-up.

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.

Studies on 200 Cases of Early Squamous Cell Carcinoma of the Cervix

Two hundred cases of early squamous cell carcinoma of the cervix were studied, 109 with early stromal invasion (ESI) (FIGO stage Ia1) and 91 microcarcinomas (MCs) (stage Ia2). Nine percent of invasive foci arose from original (native) squamous epithelium, outside the transformation zone. What may have been "skip lesions" (see text) were seen in only two instances. Of the cases of ESI, 78% invaded to < or = 0.5 mm. Of the MCs, 65% invaded to < or = 3 mm, and > 50% measured < or = 50 mm3 in volume. Capillary-like space involvement (CLSI) was suspected in 32 cases (29%) of MC on hematoxylin and eosin (H&E) staining but could not be confirmed by Ulex europeaus agglutinin I lectin immunoperoxidase staining in 10. Forty-four MCs displayed a spray-like growth pattern, 34 a confluent pattern, and 12 both; one had a condylomatous appearance. Forty-eight MCs were grade 3, 27 were grade 2, and 16 were grade 1 in differentiation. Stromal response was assessed as absent in nine cases, weak in 53, moderate in 58, and intense in 80. The extent of associated cervical intraepithelial neoplasia (CIN) was widespread in all but nine cases. There were seven recurrences, including one definite and one possible tumor-related death. A single case of residual disease was observed. The new FIGO classification of preclinical stage Ia carcinoma as that diagnosed only by microscopy is sound. The division into stages Ia1 and Ia2 is reproducible and may be used for comparison between various institutions; the notion, however, that the length of MC should form part of its definition is not supported by these data. None of the variables (depth of invasion, length, area, volume, growth pattern, grade, stromal response, and CLSI) had any bearing on prognosis. Although stromal invasion can certainly be seen in small punch biopsies, a definitive diagnosis can be made only in conization (or hysterectomy) specimens. It is absolutely essential that conization specimens be thoroughly sampled, not only to make the correct diagnosis but also to be certain about the margins. Early stromal invasion behaves in the same manner as CIN and may be treated by conization alone provided the cone has been adequately sampled and the margins are free. Much the same applied to MC, although there were not enough patients whose tumors were associated with CLSI to be absolutely certain of the prognostic significance of the latter.

The Royal College of Obstetricians and Gynaecologists micro-invasive carcinoma of the cervix study: preliminary results.

To determine how micro-invasive carcinoma of the cervix is diagnosed and treated in the United Kingdom. To record the frequency of the various pathological features which comprise the histological diagnosis of micro-invasion, and to assess their relevance to outcome. Prospective observational study. Hospitals throughout the United Kingdom. Two hundred and eighty-six cases were submitted for entry into the study. Following independent review of the histological material 116 cases were excluded: 41 were not accompanied by histological slides for review, 55 had no evidence of invasive disease, 17 had invasive disease greater than FIGO Stage 1a, and three were adenocarcinomas. The remaining 170 cases were registered for the study but follow up was incomplete in 18. This report concerns the 152 women with complete follow up to 1991. The age of the 152 women ranged from 22 to 65 years (median 36 years). In 116 women (76%) the diagnosis was made by cone biopsy (cold knife, loop diathermy, or laser) or wedge biopsy, in 9 women (6%) the diagnosis was made by hysterectomy, and in 27 women (18%) punch biopsy suggested an invasive lesion and subsequent excisional treatment (including radical hysterectomy with node dissection in three) demonstrated micro-invasion. The depth of invasion was up to 3 mm in 142 women (93%) and 3.1 to 5 mm in 10 women (7%). Capillary-like space involvement was present in 12 women (8%). Treatment methods used were local cervical surgery in 79 women (52%), simple hysterectomy in 63 (41%), and radical hysterectomy in 10 (7%). There was only one known recurrence and death due to cervical carcinoma. There is no uniformity in the management of micro-invasive carcinoma of the cervix. The frequency of recurrence, lymph metastases, and death is low. Nonradical surgery appears to give satisfactory results.

Ulex Europaeus 1 Lectin for Demonstration of Lymphovascular Involvement in Microinvasive Carcinoma of the Cervix

AbstractLymphovascular invasion in microinvasive carcinoma of cervix may be an important prognostic indicator. However, a variety of tissue artifacts can make recognition of this invasion difficult in hematoxylin and eosin (H & E) sections. Ulex europaeus agglutinin I lectin (UEA I) used in an immunoperoxidasen technique as an endothelial cell marker facilitates the diagnosis. In this study, 32 cases with suspected vascular involvement were reacted with UEA I on both freshly cut paraffin sections and destained H & E slides. When blocks were available, adjacent sections were also studied with factor VIII antibody. Although there were problems with interpretation in some cases, there was good agreement between what was regarded as vascular space with routine staining and what was revealed with UEA I. Factor VIII was unhelpful. We concluded that UEA I immunohistochemistry is a useful adjunct for assessing capillary-like space involvement in microinvasive carcinoma of cervix. (The J Histotechnol 16:175, 1993)

Clinicopathologic analysis of uterine malignant mixed müllerian tumors

A clinicopathologic evaluation of 60 patients (median age, 66 years) presenting for primary treatment of uterine malignant mixed müllerian tumors between 1959 and 1982 was conducted. Surgical stage was utilized for assessment of survival by stage. With a minimum follow-up of 5 years, overall 2- and 5-year Kaplan-Meier survival estimates were 53 and 39%, respectively; they were 75 and 58% when disease was confined to the uterus and 27 and 15% when disease extended beyond the uterus. By log-rank and logit-rank analysis, surgical stage and depth of invasion stratified by stage were significant prognostic determinants; no significant association was found with carcinoma grade, sarcoma mitotic figure count, sarcoma histologic subtype, sarcoma necrosis, or capillary-like space involvement. No significant survival advantage was found for surgery plus irradiation or surgery plus chemotherapy compared with surgery alone after stratification according to stage. Progression-free survival after complete extirpation of macroscopic disease was not significantly different, stage for stage, between surgery alone and surgery plus radiotherapy.

Positive groin lymph nodes in superficial squamous cell vulvar cancer: A gynecologic oncology group study

The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers ≤5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of these superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patients with suparficial vulvar cancer are tumor thickness, histologic grade (proportion of undifferentiated tumor pattern), capillary-like space involvement with the tumor, clitoral or perineal location, and clinically suspicious nodes, according to the linear logistic model analysis of clinicopathologic data in 272 women. No lymph node metastases occurred in approximately one fourth of patients with a combination of low-risk factors: no clinically suspicious nodes, negative capillary-like space, and nonmidline vulvar cancers that were either grade 1 and 1 to 5 mm thick or grade 2 and 1 to 2 mm thick. In contrast, all 10 patients with clinically suspicious nodes and grade 4 tumors had positive groin nodes. The risk of lymph node metastases in best determined by simultaneous evaluation of all risk factors rather than a single factor such as tumor thickness.

Positive groin lymph nodes in superficial squamous cell vulvar cancer

Abstract The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers ≤5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of these superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patients with suparficial vulvar cancer are tumor thickness, histologic grade (proportion of undifferentiated tumor pattern), capillary-like space involvement with the tumor, clitoral or perineal location, and clinically suspicious nodes, according to the linear logistic model analysis of clinicopathologic data in 272 women. No lymph node metastases occurred in approximately one fourth of patients with a combination of low-risk factors: no clinically suspicious nodes, negative capillary-like space, and nonmidline vulvar cancers that were either grade 1 and 1 to 5 mm thick or grade 2 and 1 to 2 mm thick. In contrast, all 10 patients with clinically suspicious nodes and grade 4 tumors had positive groin nodes. The risk of lymph node metastases in best determined by simultaneous evaluation of all risk factors rather than a single factor such as tumor thickness.

Radical hysterectomy as therapy for early carcinoma of the cervix

During a 13-year period, 268 radical hysterectomies and pelvic lymphadenectomies were performed for Stage IB and IIA carcinoma of the cervix at Duke University Medical Center. Fifteen percent of patients had lymph node metastasis. Substage, histologic features, grade, capillary-like space involvement, and lesion size did not appear to affect nodal status. Survival was related to lymph node metastasis, status of surgical margins, and lesion size. Judicious use of radiation therapy after hysterectomy may have improved survival in high-risk patients. There does not appear to be any contraindication to operation in this group of patients as long as the condition is deemed medically operable.

Management of Stage IA carcinoma of the cervix

One hundred fourteen patients with Stage IA carcinoma of the cervix were retrospectively reviewed in regard to depth of invasion, capillary-like space involvement, stromal reaction, status of conization margins, and the incidence of lymph node metastasis. Type of treatment, recurrences, and deaths were also evaluated. Patients with less than 3 mm invasion can be treated conservatively, including conization, if fertility is desired. No lymph node metastasis or recurrence appeared in this group of patients irrespective of type of treatment. Patients with 3 to 5 mm invasion do appear to be at higher risk for recurrence, but conservative therapy may be used in individualized situations. Size of conization and status of surgical margins appear to be important determining factors in regard to conservative therapy. Data in the literature, as well as our experience, although limited, suggest that the status of capillary-like space involvement does not influence lymph node metastasis or recurrence. Invasion of 5 mm or more in depth should be treated as a Stage IB occult lesion.

Microinvasive Carcinoma of the Uterine Cervix

Abstract Of 265 patients accessioned to a study of microinvasive carcinoma of the cervix by participating institutions in the Gynecologic Oncology Group, 132 were rejected after preliminary review because of no evidence of invasion (99 patients), invasion in excess of 5 mm. (18 patients), inadequate conization (nine patients), and protocol violations (six patients). The data available for the 133 evaluable patients included clinical patient information, operative reports, narrative pathology reports, and microscopic slides. Tumor penetration was less than 2 mm. in 90 patients (67.5 per cent) and greater than 3 mm. in 21 patients (16 per cent). Lateral tumor extension was less than 4 mm. in 76 patients (57 per cent) and wider than 8 mm. in 29 patients (22 per cent). Extensive lateral spread was observed more frequently than deep penetration. Positive correlation was noted between the depth of penetration and lateral extension. Capillary-like space invasion by tumor was noted in 31 cases (23 per cent) and increased with depth of penetration. Lack of tumor differentiation occurred in patients with less than 1 mm. penetration more frequently than in those with deep penetration. A confluent pattern of tumor was observed more frequently with advanced depth of penetration and greater lateral spread. There was a strong correlation with residual tumor on hysterectomy specimen and capillary-like (CL) space involvement with deep stromal penetration and extensive lateral spread. No positive lymph nodes were observed in the 74 patients treated by radical hysterectomy and recurrence was noted in two patients with extensive CL space involvement. Conization specimens with surgical margins involved with cancer are inadequate for diagnosis of microinvasion and constitute a clear indication for management as a frankly invasive lesion. Simple hysterectomy may be the mode of therapy in patients with questionable invasion, with invasion less than 2 mm. in depth and 4 mm. in width, and without evidence of CL space invasion. Such conservative treatment is unwarranted if the conization margin is inadequate, if the margins are not clear, if invasion is deeper than 2 mm., if lateral spread is greater than 4 mm., or if tumor is present in the CL spaces.