Microinvasive Squamous Cell Carcinoma Research Articles

Comparative evaluations of different surgical and non-surgical treatment methods for early invasive and micro invasive squamous cell carcinoma in the oral and maxillofacial regions: A systematic review

Objectives: The pathogenesis and progressive behavior of head, neck, oral and maxillofacial (HNOMF) squamous cell carcinoma (SCC) has been suggested to be a multistep and multifactorial procedure that necessitates epithelial hyperplasia, epithelial dysplasia, micro invasive squamous cell carcinoma (MISCC) and early invasive squamous cell carcinoma (EISCC); EISCC and MISCC might have a completely different behavior and development process. There are only a limited number of reported HNOMF cases of EISCC or MISCC. There are still no guidelines for the treatment of EISCC and MISCC lesions in the HNOMF regions. Material and Methods: This systematic review was conducted to gather all surgical and non-surgical treatments for EISCC and MISCC lesions in the HNOMF. The study question according to the PICO format was as followed: clinical and histopathological results (O) of all types of treatments (I) for patients with EISCC and MISCC lesions in HNOMF (P) compared to untreated lesions (C). Medline, Scopus, and Google Scholar were searched and the search was limited to English-language. Results: Eight clinical human studies were included. Photodynamic therapy (PDT) after topical application of methyl aminolevulinate (MAL-PDT) and topical Imiquimod 5 % cream both had remarkable outcomes. Conclusions: However, due to the very limited number of studies conducted on the treatment methods of MISCC and EISCC in the HNOMF regions, further studies are necessary to provide reliability for non-surgical treatment methods.

Copy Number Profiling Implicates Thin High-Grade Squamous Intraepithelial Lesions as a True Precursor of Cervical Human Papillomavirus-Induced Squamous Cell Cancer

Full-thickness high-grade squamous intraepithelial lesions (HSIL) are precursors of invasive cervical squamous cell carcinoma (SCC). The World Health Organization and Lower Anogenital Squamous Terminology Standardization Project for human papilloma virus (HPV)–associated lesions divide full-thickness HSIL of the cervix into thin HSIL with thickness of 1 to 9 cell layers and the typical full-thickness HSIL of >10 cell layers. Although HPV oncogene transcripts and p16ink4a overexpression, as markers of transforming HPV infection, are detectable in thin HSIL, the biological significance of thin HSIL in cervical carcinogenesis remains poorly understood. To further characterize thin HSIL, we performed a comparative study of chromosomal copy number variations (CNV), an analysis of dysregulated genes present in the segments with CNV, and a generalized genetic complexity calculation for 31 thin HSIL, 31 thick HSIL, 24 microinvasive SCC (pT1a SCC), and 22 highly invasive SCC samples. Thin HSIL share various CNV and specific dysregulated gene pathways with thick HSIL and invasive SCC. Thin HSIL exhibited an average CNV of 11.6% compared with 14.1% for thick HSIL, 15.5% for pT1a SCC, and 26.6% for highly invasive SCC. The CNV included gains at 1q and 3q (40% and 43%, respectively), partial loss of 3p, and loss of chromosomes 11 (18%), 16 (50%), 20 (35%), and 22 (40%). Pathways affected solely in thin HSIL were those enhancing immune evasion and primarily involved the (interleukin) IL6, IL21, and IL23 genes. ILs are transiently upregulated in response to infection and play a crucial role in mounting antitumor T-cell activity. Deregulation reflects an attempt by the HPV to evade the initial immune response of the host. The primary pathways shared by thick HSIL and invasive SCC were interactions between lymphoid and nonlymphoid cells, NOTCH2 signaling, tight junction interactions (primarily of the claudin family), and FGR2 alternative splicing. Our results show that thin HSIL carry similar genetic changes as thick HSIL and SCC, indicating that thin HSIL are true precursor lesions that can progress to thick HSIL and SCC.

Leiomyosarcoma of the esophagus, arising from lamina muscularis mucosae, in a combination with microinvasive squamous cell carcinoma-A case report.

Leiomyosarcoma of the esophagus is a very rare disease, accounting for less than 0.5% of malignant esophageal tumors. Esophageal leiomyosarcoma combined with squamous cell carcinoma is even rarer than solitary leiomyosarcoma. To our knowledge, there are less than ten cases of simultaneously diagnosed leiomyosarcoma and squamous cell carcinoma of the esophagus. A 66-year-old male was admitted to our hospital suffering from epigastric pain, asthenia, weight loss, and difficulties when feeding with solid food which had been present for 2 weeks. A computed tomography scan showed a large tumor tissue mass in the mid-to-distal part of the esophagus. The patient underwent robot-assisted surgery-an esophagectomy with esophagogastrostomy. Histologically, the tumor consisted of highly pleomorphic spindle cells with multiple atypical mitosis and necrotic areas. An immunohistochemical examination was performed to distinguish leiomyosarcoma from spindle cell squamous carcinoma or malignant GIST. Tumor cells stained diffusely positive for smooth muscle actin, but negative for p63, CD117, and CKAE1/AE3. Tumor invasion involved mucosa and submucosa, without tunica muscularis propria. Microinvasive well-differentiated squamous cell carcinoma was also noted in the mucosa at the borders between the tumor and the healthy part of the esophagus. The aim of the manuscript is to present an extremely rare case of combined polypoid leiomyosarcoma and microinvasive squamous cell carcinoma of the esophagus, cured by robot-assisted surgical intervention and to emphasize that such cases should be examined carefully, including additional diagnostic tests such as Immunohistochemistry (IHC) in order to define the correct diagnosis.

Correlation of Depth of Invasion and P53 Immunoexpression in Microinvasive Oral Squamous Cell Carcinoma

Abstract Background: Oral squamous cell carcinoma (OSCC) is a major health problem and considered as the main reason for the mortality from oral diseases in most of the countries. One aspect of the OSCC was least discus in the literature that is microinvasive squamous cell carcinoma which is an early-stage tumor without invasion of deep tissues. this study is humble attempt to recognized and measured depth of invasion of infiltrative neoplastic cells to categories microinvasive oral squamous cell carcinoma (MIOSCC) and find suitable treatment plan for it Aim and objectives: To evaluate the depth of invasion and p53 immunoexpression in MIOSCC. To correlate the depth of invasion with p53 immunoexpression in MIOSCC. Material and Methods: The study included histopathologically diagnosed 25 cases of MIOSCC from the archives of the Department of Oral Pathology and Microbiology. Result: The depth of invasion was measured from the basement membrane or in areas of basement membrane loss and from an imaginary line reconstructing the basement membrane from the adjoining epithelium to the deepest point of invasion in connective tissue on research microscope. The p53 expression in the tissue section was seen through immunohistochemistry. Conclusion: There are no definite guidelines for histological grading and final treatment protocol for MIOSCC. The assessments of depth of invasion through p53 immunoexpression may be one of the criteria for grading in MIOSCC. Thus the correlation of p53 immunoexpression with the depth of tumor in MIOSCC helps to determine the treatment modalities of MIOSCC.

Clinicopathological comparison and assessment of Ki67, p53 and c-myc immunoexpression in carcinoma cuniculatum, verrucous carcinoma and microinvasive squamous cell carcinoma of the oral cavity

ObjectiveTo illustrate the clinicopathological comparison of carcinoma cuniculatum (CC), verrucous carcinoma (VC) and microinvasive squamous cell carcinoma (MISCC) and to compare the immunoexpression Ki67, p53 & c-myc in these entites. Material and methodsClinical and histopathological parameters observed in total 67 cases (12 cases of CC, 22 cases of VC and 27 cases of MISCC). Ki67 & p53 labelling index and c-myc immunoexpression (localization of stain (1: cytoplasmic; 2: nuclear; 3: both), intensity of stain (1: mild; 2: moderate; 3: strong) and distribution of stain in epithelium (1: basal third; 2: up to middle third; 3: up to upper third; 4: invasive islands)). ResultsCC predominantly showed keratin filled crypts, keratin microabscess, microsequestra formation and lymphocytic exocytosis. VC showed broad pushing invasive front, parakeratin plugging along with verrucous projections. Irregular infiltrating rete ridge pattern and severe cytological atypia were findings of MISCC. Ki67 LI was 12.70 % in CC, 23.34 % in VC and 28.27 % in MISCC. p53 LI was 44.167 % in CC, 30.18 % in VC and 29.51 % in MISCC. Ki67 LI showed statistically significance difference between CC and MISCC. Moderate to strong cytoplasmic immunoexpression was found in epithelium as well as in invasive islands of MISCC compared to CC and VC. ConclusionCC shows endophytic epithelium proliferation with mild to moderate dysplasia and no definite invasive front in contrast to VC. High p53 in CC basal cells correlate with more endophytic epithelial proliferation. Significant high Ki67 LI in invasive islands of MISCC supports its aggressive nature. p53, Ki67 and c-myc panel may be helpful as an adjunct in difficult cases with poorly oriented specimens.

Unilateral ovarian recurrence 5 years after hysterectomy for microinvasive squamous cervical cancer stage IA1: a rare case report

BackgroundOvarian metastasis or recurrence of cervical microinvasive squamous cell carcinoma (SCC) is very rare. We report a case of unilateral ovarian recurrence 5 years after hysterectomy for the SCC stage IA1 without lymph vascular space invasion (LVSI).Case presentationA 49-year-old female patient suffered from a dull pain in the left lower abdomen for 3 months. And five years ago, she received a laparoscopic hysterectomy for the treatment of stage IA1 (without LVSI) SCC of the cervix. The level of squamous cell carcinoma antigen (SCC-Ag) in serum was significantly elevated (10.60 ng/mL). Pelvic magnetic resonance imaging (MRI) revealed a left ovarian solid tumor measuring 5.5 × 3.9 × 5.6 cm with heterogeneous enhancement. During laparotomy, the left ovarian tumor was measured about 5.0 × 4.5 × 3.0 cm and seemed densely adherent to the posterior peritoneal wall, including the left ureter. The tumor and pelvic lymph node were carefully removed. Postoperative anatomy revealed a solid mass with a greyish-white section. Postoperative pathology showed recurrent moderately differentiated ovarian SCC with negative pelvic lymph nodes. Immunohistochemistry showed that the tumor cells were positive for P16, P63, P40, and CK5/6 markers, and the positive rate of Ki67 was about 80%.ConclusionsOvary preservation is reasonable and appropriate in young patients with microinvasive SCC. Ovarian recurrence is rare, but gynecological oncologists should not overlook its possibility. The serum SCC-Ag is an important indicator for monitoring postoperative disease progression.

EARLY DIAGNOSIS OF LIP CANCER: A CASE REPORT

A 53-year-old white male complained of a tongue alteration, noted by the dentist. On clinical examination, besides the lingual lesion, other changes were also observed: multiple red and blackened papules on the facial skin and atrophy of the lower lip, with loss of the interface between the skin and the labial mucosa, along with superficial and color changes, suggestive of actinic lesions (keratosis and cheilitis). Incisional biopsies were performed, and the histopathological reports were of the presence of epithelial atypia with the absence of malignancy in the tongue, compatible with microinvasive squamous cell carcinoma in the lip. The patient was an ex-smoker and had a history of chronic occupational sun exposure. This report highlights the importance of a thorough anamnesis and physical examination of the lips, often neglected by dentists. Thus, incisional biopsy and histopathological examination in actinic cheilitis, when indicated, are essential for the early detection of lip cancer. A 53-year-old white male complained of a tongue alteration, noted by the dentist. On clinical examination, besides the lingual lesion, other changes were also observed: multiple red and blackened papules on the facial skin and atrophy of the lower lip, with loss of the interface between the skin and the labial mucosa, along with superficial and color changes, suggestive of actinic lesions (keratosis and cheilitis). Incisional biopsies were performed, and the histopathological reports were of the presence of epithelial atypia with the absence of malignancy in the tongue, compatible with microinvasive squamous cell carcinoma in the lip. The patient was an ex-smoker and had a history of chronic occupational sun exposure. This report highlights the importance of a thorough anamnesis and physical examination of the lips, often neglected by dentists. Thus, incisional biopsy and histopathological examination in actinic cheilitis, when indicated, are essential for the early detection of lip cancer.

Trends in HPV- and non-HPV-associated vulvar cancer incidence, United States, 2001–2017

Vulvar cancer incidence has been rising in recent years, possibly due to increasing exposure to human papillomavirus (HPV). We assessed incidence rates of HPV-associated and non-HPV-associated vulvar cancers diagnosed from 2001 to 2017 in the United States (US). Using population-based cancer registry data covering 99% of the US population, incidence rates were calculated and stratified by age, race/ethnicity, stage, geographic region, and histology. The average annual percent change in incidence per year were calculated using joinpoint regression. From 2001 to 2017, the incidence of HPV-associated vulvar cancers increased by 1.2% per year, most notably among women who were aged 50–59 years (2.6%), 60–69 years (2.4%), and ≥ 70 years (0.9%); of White (1.5%) and Black (1.1%) race; diagnosed at an early (1.3%) and late (1.8%) stage; and living in the Midwest (1.9%), Northeast (1.4%), and South (1.2%). Incidence increased each year for HPV-associated histologic subtypes including keratinizing (4.7%), non-keratinizing (6.0%), and basaloid (3.1%) squamous cell carcinomas (SCCs), while decreases were found in warty (2.7%) and microinvasive (5.5%) SCCs. HPV-associated vulvar cancer incidence increased overall and among women aged over 50 years while remaining stable among women younger than 50 years. The overall incidence for non-HPV-associated cancers was stable. Continued surveillance of HPV-associated cancers will allow us to monitor future trends as HPV vaccination coverage increases in the US.

Tumor-associated tissue eosinophilia in preinvasive and invasive squamous cell carcinoma of cervix

Background: Differentiating between preinvasive and invasive squamous neoplasms of the cervix can be a challenge in small, superficial fragments of cervical biopsy, particularly when inflammatory infiltrates obscure the epithelial stroma interface and due to tangential sectioning of the acanthotic squamous epithelium. This study evaluates whether thresholds of eosinophils in stroma serve as a morphological marker for the presence of tumor invasion in squamous neoplasms of the cervix. Material and methods: Sixty-five cases of invasive squamous cell carcinoma and preinvasive squamous neoplasia were evaluated. In each case, the number of eosinophils per HPF and per 10 HPF in the tissue adjacent to the neoplastic epithelium was counted. For statistical purposes, the elevated eosinophils were categorized as > 3 eosinophils/HPF, > 5 eosinophils/HPF, and >10/10 HPF. Results: Stromal eosinophils were present in 1/5 cases of LSIL, 3/8 HSIL cases, 15/16 cases of microinvasive squamous cell carcinoma, and 34/36 cases of invasive squamous cell carcinoma, signifying an increase in eosinophil count from a spectrum of preinvasive to invasive carcinoma. Greater than 5 eosinophils/HPF and >10 eosinophils/10 HPF had sensitivity, specificity, and positive predictive values of 55%, 100%, 100%, and 75%, 100%and 100%, respectively. The difference of >5eosinophils/HPF and >10eosinophils/10 HPF between SIL and SCC was statistically significant. Conclusions: Our study suggests that the presence of increased eosinophils in squamous neoplasia of the cervix can be associated with tumor invasion and should prompt a thorough evaluation when evidence of invasion is absent.

EARLY DIAGNOSIS AND TREATMENT IN TWO CASES OF MICROINVASIVE SQUAMOUS CELL CARCINOMA ON THE PALATE

Squamous cell carcinoma (SCC) is the most common malignancy that affects the oral cavity. It is related to smoking and drinking, which can increase the carcinogenic effect. The objective of the work is to report 2 cases of microinvasive SCC, presenting their clinical characteristics and emphasizing early diagnosis and clinical management. Case 1: A 65-year-old male smoker undergoing treatment for prostate adenocarcinoma with bone metastasis and use of alendronate complained of bilateral white plaques on the palate without painful symptoms. Case 2: A 43-year-old female smoker with no comorbidities presented with a shallow ulcer in the palate region. The diagnostic hypotheses were mild dysplasia and SCC. Incisional biopsies were performed and histopathologic reports revealed microinvasive SCC. The patients were referred for treatment. It was concluded that the dentist must be attentive to the diagnosis of oral lesions for a favorable prognosis and patient survival. Squamous cell carcinoma (SCC) is the most common malignancy that affects the oral cavity. It is related to smoking and drinking, which can increase the carcinogenic effect. The objective of the work is to report 2 cases of microinvasive SCC, presenting their clinical characteristics and emphasizing early diagnosis and clinical management. Case 1: A 65-year-old male smoker undergoing treatment for prostate adenocarcinoma with bone metastasis and use of alendronate complained of bilateral white plaques on the palate without painful symptoms. Case 2: A 43-year-old female smoker with no comorbidities presented with a shallow ulcer in the palate region. The diagnostic hypotheses were mild dysplasia and SCC. Incisional biopsies were performed and histopathologic reports revealed microinvasive SCC. The patients were referred for treatment. It was concluded that the dentist must be attentive to the diagnosis of oral lesions for a favorable prognosis and patient survival.

TONGUE MICROINVASIVE CARCINOMA: CASE REPORT

Squamous cell carcinoma (SCC) represents the main malignancy of oral mucosa and lips and is the sixth most common cancer in the world. The tongue is the most common anatomical site. Microinvasive carcinoma is an early-stage, relatively thin tumor, without invasion of deep tissues. The objective of this work is to report a case of microinvasive SCC and present its clinical characteristics, emphasizing early diagnosis and clinical management. A 64-year-old male patient reported a "sore on the tongue that doesn't heal." The clinical examination demonstrated 2 white plaques on the lateral border of tongue associated with an erythematous area (atrophic). The diagnostic hypotheses were erosive lichen planus and lichenoid reaction. Incisional biopsies were performed, and histopathologic reports revealed microinvasive SCC. The patient was referred for treatment. Because microinvasive lesions tend to present clinically as premalignant lesions, accurate clinical examination is essential if misdiagnosis of early lesions is to be avoided.

SQUAMOUS CELL CARCINOMA OF THE LOWER LIP IN FATHER AND SON

Squamous cell carcinoma (SCC) of the lower lip typically has a good prognosis when diagnosed at an early stage and treated properly. The objective of this work is to report 2 cases of SCC of the lower lip in a father and son and present their clinical characteristics. A 70-year-old White male smoker and drinker reported painful symptoms in a lower lip wound. On clinical examination, the wound was well defined and had an erythematous area. He reported that 5 years ago he had a tumor removed at the same site. The biopsy revealed SCC. In next month, the patient's son (42 years old) reported to the clinic worried about a white plaque present on his lip. He revealed smoking and drinking habits and chronic exposure to the sun. The diagnostic hypothesis was actinic cheilitis with a leukoplastic area. A biopsy was performed, which revealed microinvasive SCC. Both patients were successfully treated.

HYBRID VERRUCUS CARCINOMA OF THE ORAL CAVITY: A CASE REPORT AND REVIEW OF THE LITERATURE

Introduction: Verrucous carcinoma (VC) of the oral mucosa is a rare type of non-metastatic, low-grade and well differentiated squamous cell carcinoma. The neoplasm is typically presented with a slow and superficial growth in elderly males. Various factors are known to implicate in its pathogenesis and affect the progression and prognosis of the neoplasm. When invasive atypical areas are present, VC is then described as hybrid verrucous carcinoma (HVC). Case Report: A 55-year-old woman was referred with an elevated leukoplakic verrucous lesion on the dorsal surface of the tongue, measuring 2 cm at its maximum diameter. The patient had been a smoker for ten years with no pertinent past medical history. An incisional biopsy had already been performed a month before referral with the histopathology report of an atypical verrucous papillary lesion. An excisional biopsy was performed at the referral and the lesion was resected with a spindle-shaped surgical incision circumcising the neoplasm within safety margins. The final histopathology report made the diagnosis of VC with multiple foci of microinvasive squamous cell carcinoma (verrucous carcinoma – hybrid type). Conclusion: Differential diagnosis of VC still remains a challenge and various clinical, histopathological and immunohistochemical parameters should be considered. The treatment of choice for VC is surgical excision within safety margins. A clinical follow-up should then be scheduled for these patients and they must remain alert for any changes of the oral mucosa for the future.

Conservative treatment of microinvasive squamous cell carcinoma of the cervix stage IA1: Defining conization height to an optimal oncological outcome.

ObjectiveThis paper searches an ideal cone height for stage definition and safe treatment of cervical microinvasive squamous carcinoma stage IA1 (MIC IA1), avoiding excessive cervix resection, favoring a future pregnancy.MethodsA retrospective study was performed involving 562 women with MIC IA1, from 1985 to 2013, evaluating cone margin involvement, depth of stromal invasion, lymph vascular invasion, conization height, and residual uterine disease (RD). High-grade squamous lesions or worse detection was considered recurrence. Univariate and multivariate regression analyses were performed, including age, conization technique (CKC, cold-knife, or ETZ, excision of transformation zone), and pathological results. Conization height to provide negative margins and the risk of residual disease were analyzed.ResultsConization was indicated by biopsy CIN2/3 in 293 cases. Definitive treatments were hysterectomy (69.8%), CKC (20.5%), and ETZ (9.7%). Recurrence rate was 5.5%, more frequent in older women (p = 0.030), and less frequent in the hysterectomy group (p = 0.023). Age ≥40 years, ETZ and conization height are independent risk factors for margin involvement. For ages <40 years, 10 mm cone height was associated with 68.6% Negative Predictive Value (NPV) for positive margins, while for 15 mm and 25 mm, the NPV was 75.8% and 96.2%, respectively. With negative margins, the NPV for RD varied from 85.7–92.3% for up to 24 mm cone height and 100% from 25 mm.ConclusionConization 10 mm height for women <40 years provided adequate staging for almost 70%, with 10% of RD and few recurrences. A personalized cone height and staging associated with conservative treatment are recommended.

Correlation of p53 Immunoexpression with Depth of Tumor in Microinvasive Oral Squamous Cell Carcinoma

Introduction: “Oral squamous cell carcinoma (OSCC)” is a major health issue in India, the incidence of OSCC is 3-7 times more in developing countries than developed countries. OSCC is the ‘3rd most common cancer’ in India followed by “cervical and breast cancer”. One side of OSCC that has not much explore is the ‘microinvasive squamous cell carcinoma’ which is an early stage neoplasm without infiltration in the deeper tissues. There is no particular definition of “microinvasive oral squamous cell carcinoma (MIOSCC)” There are no specific guideline are present to categories the “microinvasive squamous cell carcinoma (MIOSCC)”. Most of the time the infiltrating neoplastic cells are masked under the background of the inflammatory cell infiltrate present connective tissue stroma. So this study is humble attempt to recognized and measured depth of invasion of infiltrative neoplastic cells to categories MIOSCC and to find better management protocol for it&#x0D; Aim: This study aims to: Measure p53 immunoexpression in “microinvasive oral squamous cell carcinoma, evaluate the depth of invasion in MIOSCC in H &amp; E stained section, and correlate the p53 immunoexpression with the depth of tumor in it.&#x0D; Methodology: The 25 cases of “microinvasive oral squamous cell carcinoma” will be selected and 10 cases of “normal oral mucosa (NOM)” will be obtained from “gingiva and vestibular mucosa” as controls after extraction of impacted teeth. “The depth of tumor” will be measured from the “basement membrane or in areas of basement membrane loss, from an imaginary line reconstructing the basement membrane from the adjacent epithelium to the deepest point of invasion in connective tissue” by Leica DMLB2 research microscope with Leica Q-win standard software (Switzerland).&#x0D; Results: The results show that the depth of invasion in MIOSCC, will be categorized the lesion and give the better guidelines for histological grading and treatment protocol for MIOSCC&#x0D; Conclusion: There are no definite guidelines for histological grading and final treatment protocol for MIOSCC. The assessments of depth of tumor through p53 immunoexpression may be one of the criteria for grading in MIOSCC. Thus the correlation of p53 immunoexpression with the depth of tumor in MIOSCC helps to determine the treatment modalities of MIOSCC.

The oncological and obstetric outcomes of cervical squamous cell carcinoma at stage IA1 managed with the loop electrosurgical excision procedure

ObjectiveTo evaluate the efficacy and superiority of loop electrosurgical excision procedure (LEEP) in managing stage IA1 cervical microinvasive squamous cell carcinoma (MISCC) without lymph-vascular space invasion (LVSI). Materials and methodsThe oncological and reproductive outcomes of a series of patients affected by stage IA1 MISCC without LVSI, initially treated by LEEP between February 2006 and December 2017, were retrospectively reviewed. ResultsUltimately, 109 patients were included. The mean age at diagnosis was 35.4 years old, and 36 patients were nulliparous. Multifocal lesions were identified in 15 patients (13.8%). The mean cone depth was 17.4 mm. Resection margins were positive/unevaluable and negative in 26 (23.9%) and 83 (76.1%) cases, respectively. Among cases undergoing salvage treatments, the residual disease rate for patients with positive/unevaluable margins was significantly higher than those with negative margins (P = 0.003). During the follow-up period of 43.0 ± 28.9 months, no relapse was identified. Fifteen of 20 patients (75.0%) conceived successfully, with a full-term live birth rate of 93.3%. ConclusionsFor stage IA1 MISCC without LVSI unexpectedly found in a loop excision, initial LEEP with clear margin is efficient and adequate. For cases with multifocal MISCC, or for those young patients who wish to become pregnant in the future, LEEP is the optimal choice.

Tip of the iceberg: Immunohistochemical markers reveal malignant transformation underneath a vocal polyp surface

Novel molecular techniques including markers of laryngeal carcinogenesis could improve the difficult diagnosis of a wide array of laryngeal polypoid changes. The case reported herein shows that not every clinically diagnosed vocal fold polyp is a benign lesion as mostly considered in the literature. Further assessment including carcinogenesis markers detected a nest of micro-invasive squamous cell carcinoma. Therefore, we recommend biopsy backed up with immunohistochemical analysis whenever there is a suspicious polypoid formation in order to exclude or confirm a malignant transformation because of the possibility of multi-focal growth in the active laryngeal epithelium.

PET/MR imaging for the evaluation of cervical cancer during pregnancy

BackgroundMalignancy during pregnancy is increasing, and the most common type of malignancy is uterine cervical cancer. When planning the treatment of cervical cancer, it is important to look for signs of metastasis before surgery, especially metastasis to the lymph nodes. In this report, we assessed the diagnostic value of positron emission tomography/magnetic resonance imaging (PET/MRI) for evaluating cervical cancer propagation before surgery, with a focus on pregnant women.Case presentation18F Fluorodeoxyglucose (FDG)-PET/MRI was performed in seven pregnant cervical cancer patients (28–34 years old) at 9–18 gestational weeks. In case #5, a second PET/MRI was performed at 24 gestational weeks. Of seven FDG-PET/MRI examination series in six cases (cases #1–6), FDG-PET/MR imaging could detect cervical tumors with abnormal FDG accumulation; these tumors were confirmed with a standardized uptake value max (SUV max) titer of 4.5–16. A second PET/MRI examination in case #5 revealed the same SUV max titer as the first examination. In these six imaging series (cases #1–5), there were no signs of cancer metastasis to the parametrium and lymph nodes. However, in case #6, abnormal FDG accumulation in the left parametrial lymph nodes was also detectable. Pathological examination showed lymph node metastasis in case #6. In case #7, PET/MRI could not detect any abnormal FDG accumulation in the cervix and other sites. Cone biopsy demonstrated only micro-invasive squamous cell carcinoma. After treatment for cervical cancer, all seven patients have had no recurrence of disease within the follow-up period (2.8–5.6 years), and their children have developed appropriately.ConclusionPET/MRI is an effective imaging tool to evaluate cervical cancer progression in pregnancy.

Ichthyosis uteri with carcinoma cervix

Ichthyosis uteri is a rare condition in which the entire surface of the endometrium undergoes metaplasia and is replaced by stratified squamous epithelium. This change is the endometrial response to iatrogenically introduced caustic substances and a variety of inflammatory conditions of the endometrium. We describe herein microinvasive squamous cell carcinoma of the uterine cervix with extensive ichthyosis uteri-like changes in the adjacent endometrium. The possible origin of these complex findings and the neoplastic potential of ichthyosis uteri is also discussed.

Micro-invasive squamous cell carcinoma of gastro-esophageal junction in a teenage female: A rare case report

Squamous cell carcinoma (SCC) of upper gastrointestinal (GI) tract is an aggressive malignancy more common in older age group. Post 1970’s with advent of endoscopy and the discovery of H. pylori bacteria and with it’s role in malignancy of esophagus and stomach, detection rate of squamous cell carcinoma esophagus has increased subsequently. In this case report we present a case of squamous cell carcinoma gastroesophageal (GE) junction in a 15 years old female owing to its rarity in younger age. The patient presented in the surgery OPD with history of weight loss and dysphagia since the last 5 months. She also complained of epigastric pain and heartburn since the last 2 months. There was no past history of carcinoma of GIT in any family members. Upper GI endoscopy showed an exophytic growth at the GE junction. Histopathological examination of subsequent GE biopsy confirmed the diagnosis of micro-invasive squamous cell carcinoma while the stomach showed features of chronic atrophic gastritis. The patient underwent resection of GE junction through thoraco-abdominal approach followed by radiotherapy for any residual tumour. Our patient is doing well after 3 months post op follow up. This case report emphasises the rare occurrence of SCC in a teenage female with no family history and to consider it in the differential diagnosis in younger patients with similar complaints.