Histopathological Evaluation of Post Radio-Chemotherapy Response on Hysterectomy Specimens for Cervical Carcinoma
GF Zannoni, VG Vellone, S Sioletic, F Morassi, G Fadda. Catholic University, Rome, Italy
Background: The examination of post radio-chemotherapy specimens represents a challenging issue. Cytotoxic therapies produce morphological changes that make the interpretation of these specimens extremely arduous. The evaluation of the residual disease is critical for the prognosis and planning of further treatments.
Design: The study group included 124 cervical cancers (mean age 53,812,3 years) treated with radio-chemotherapy followed by radical surgery. 95 patients had a pre-treatment biopsy: Squamous Carcinoma: 79 (89.1%); Adenocarcinoma: 10 (10.5%); Adenosquamous Carcinoma: 7 (5.3%); Other: 2 (2,1%). The cervix was sectioned clockwise, entirely embedded in 12-24 paraffin blocks and enterely examined. The local response to therapy was evaluated as follows: - pR0: Pathological Complete Response: absence of residual neoplastic cells. - pR1: Pathological Partial Response: presence of clusters of neoplastic cells <0.3 cm - pR2: Pathological No Response: presence of neoplastic mass 0.3 cm. All the patients were restaged according to AJCC staging manual and FIGO. FIGO stage 0-II were considered as Local Disease; FIGO stage III-IV as Disseminated Disease.
Results: Residual neoplastic cells showed: cytoplasmic eosinophilia, vacuolation and foamy degeneration. Mitotic activity was scanty. The stroma was fibrous containing inflammatory cells, fibrinous debris, cholesterol clefts and hemosiderin. We found 45 pR0 (36.3%); 41 pR1 (34.7%); 36 pR2 (29%); 108 patients had a Local Disease; 16 had a Disseminated Disease. Presence of neoplastic embolism represent a significant risk factor for Disseminated Disease (RR=7,1; risk increase: +671,4%; p<0,001). Tumor regression was seen in all cases with different extent; giant cells or microcalcalcifications did not yield significant in the regression groups (p>0,05). The pR2 residuals infiltrated significantly more than pR1 residuals (0.84 Vs 0.55 p<0,001) and more frequently involved the parametria (5 cases Vs 1 case). pR2 mean linear dimension was 1.60,9 cm. We did not find any difference between pR1 and pR2 in incidence of Disseminated Disease (3 cases Vs 8 cases p>0,05).
Conclusions: Neoadjuvant radio-chemotherapy strongly affects the neoplastic tissue with variable signs of regression. Neoplastic embolism is the most important histological feature to be reported. The depth of infiltration, the presence of giant cells or calcifications did not correlate with distant metastases. The residual cancer is often limited to few cells so embedding the whole cervix is suggested.
Monday, March 9, 2009 1:00 PM
Poster Session II # 151, Monday Afternoon