Invasive Endocervical Adenocarcinoma: Combining Depth and Pattern of Invasion for Better Identification of Patients with Lymph Node Metastases.
Brent Arville, Elvio Silva, Gretchen Galliano, Joanne Rutgers. Cedars-Sinai Medical Center, Los Angeles, CA; Long Beach Memorial Medical Center, CA
Background: The preferred treatment of invasive endocervical adenocarcinoma (Endocx Adenca) is surgical. The type of resection is selected based on the depth of invasion. However, pathologists do not agree on what cases are invasive and how to measure depth of invasion. Over 95% of the resected lymph nodes (LNs) are negative creating an important morbidity problem especially in young patients (Pts).
Design: We reviewed 43 cases treated as invasive Endocx Adenca. Only Pts with hysterectomy and LN resection, or a follow-up >5 years were included. We evaluated tumor size, differentiation, mitosis, necrosis, characteristics of the invasive component, depth of invasion, and vascular invasion (VI). In the area with the main invasive component smooth muscle actin (SMA) and estrogen receptor (ER) were obtained in 25 cases.
Results: The cases were separated into 3 groups: 1) Cases with well or moderately differentiated glands, regardless of their depth or proximity to large vessels. Invasion in this group was based only on the depth of the glands: 13 cases, no VI, ER+, SMA- in 71%. All (263) LNs were negative and no recurrences. 2) Cases with any differentiation but with pushing margins in the main tumor mass and minimal foci (<1 mm) of destructive invasion from the well demarcated margin of Endocx Adenca: 11 cases, 2 had suspicious VI. ER and SMA were noncontributory. All (207) LNs were negative. One Pt had a recurrence in the vagina. 3) Diffuse type of invasion deeper than 1 mm: 19 cases, VI in 7, 1 vessel in 5, and 3 or more in 2. ER- and SMA+ in 70%. 5 had LN mets and/or recurrences. 366 LNs resected in this group. The 2 Pts with 3 or more vessels + had LN mets.
Conclusions: Identifying invasion and determining its depth in Endocx Adenca is extremely difficult, therefore we propose: 1) If the possible invasive area is composed of groups of glands without destructive invasion, regardless of their depth, LN resection is not needed. 2) If there is focal, <1 mm destructive invasion but most of the Endocx Adenca is well demarcated only sentinel nodes need to be obtained. 3) If there is destructive invasion, >1 mm, a complete LN resection is indicated. 4) VI is important only when there are 3 or more vessels involved. Adding the pattern of invasion, which is easily evaluable, to the current method of depth of invasion improves prediction of LN involvement. It would have been possible to identify 24/43 (56%) Pts who did not need extensive LN resections by evaluating the pattern of invasion.
Category: Gynecologic & Obstetrics
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 129, Monday Morning