Parametrial Invasion, an Important Landmark of Cervical Cancer Treatment; How Can We Recognize It?
Su Jin Shin, Kun Young Kong, Joo-Hyun Nam, Kyu-Rae Kim. University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Background: According to the current treatment guideline of uterine cervical cancer, postoperative adjuvant treatment is indicated in patients having parametrial invasion in the radical hysterectomy specimens. Despite the importance of parametrial invasion, histological decision of parametrial invasion is often subjective because “parametrium” is a loosely defined structure and the definitive landmark has not been determined.
Design: To define a precise landmark of “parametrium”, we scrutinized cervical wall and cervico-parametrial junctions on H&E and trichrome-stained sections of type III radical hysterectomy specimens from patients with FIGO stages IB/IIA (n=22), and IIB (n=66), and compared the applicability of 3 landmarks, 1) thick & large calibered blood vessels, 2) presence of adipose tissue/loose connective tissue on the H&E sections, and 3) compact muscle layers on trichrome stainings in the decision of parametrial invasion. We also compared the applicability of those 3 landmarks in the longuitudinal (n=37) and modified transverse sectioning (n=29).
Results: In the 22 FIGO stage IB/IIA cases, inner two thirds of cervical wall was composed of either compact/hapharzardly arranged muscle bundles (55%) or sparse/hapharzardly arranged smooth muscle bundles containing abundant interstitial connective tissue stroma (45%), while outer one third of the cervical wall was consistently composed of continuous and compact muscle layers, which were clearly distinguishable from parametrium. In the decision of parametrial invasion among 66 FIGO stage IIB cases, only a single case (2%) was difficult to decide by using smooth muscle layer on trichrome staining, while 30% and 8% were difficult to decise by using large calibered blood vessels and apipose tissue/loose connective tissue, respectively. In the decision using 3 different landmarks, modified transverse sectioning gave better tissue orientation for the relationship between cervical wall and parametrium.
Conclusions: Trichrome staining for identification of compact muscle layer of cervical wall is a simple and useful method for the decision of parametrial invasion status of cervical cancer in the difficult cases, and modified transverse sectioning was very helpful to obtain important pathological informations in the radical hysterectomy specimens.
Category: Gynecologic & Obstetrics
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 221, Tuesday Morning