Female ; Humans ; Cervix Uteri/surgery* ; Carcinoma, Neuroendocrine/surgery*

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.
Female ; Humans ; Cervix Uteri/surgery* ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms/surgery* ; Carcinoma, Neuroendocrine/surgery* ; Recurrence

OBJECTIVE: To establish a prognostic model for preterm birth in women after cervical conization, and to evaluate its effectiveness. METHODS: Seventy three women after cervical conization in Women's Hospital of Zhejiang University were included for this retrospective study. The influencing factors of preterm delivery were analyzed by Logistic regression analysis and a prognostic model was created. Receiver operating characteristic (ROC) curve was used for evaluation of the predictive ability of the model. Forty five women who underwent cervical conization were included for testing the validity of the model. RESULTS: For women after cervical conization, mother's age (=1.20, 95%:1.01-1.43, <0.05) and cervical length during middle pregnancy (=0.06, 95%:0.01-0.21,<0.01) were independent predictors for preterm birth. The regression model was Logit ()=1.408-2.903×cervical length+0.186×age. The areas under the ROC curve (AUC) of the training dataset was 0.93 (95%:0.87-0.99). The sensitivity, specificity, Youden index, positive predictive value (PPV), negative predictive value (NPV) and accuracy with the cutoff value of -1.512 were 91.7%, 81.5%, 0.732, 68.8%, 95.7% and 84.5% respectively. The AUC of the testing dataset was 0.94 (95%:0.86-1.00). The sensitivity, specificity, Youden index, PPV, NPV and accuracy with the cutoff value of -0.099 were 92.9%, 90.3%, 0.832, 81.3%, 96.5% and 91.1%, respectively. CONCLUSIONS The model based on the age and cervical length during middle pregnancy can effectively predict preterm delivery in pregnant women after cervical conization.
Cervix Uteri ; surgery ; Conization ; Female ; Humans ; Models, Biological ; Pregnancy ; Premature Birth ; diagnosis ; Prognosis ; ROC Curve ; Retrospective Studies

OBJECTIVETo explore the optimal diagnosis and treatment methods for grade III cervical intraepithelial neoplasia (CINIII).

METHODSNinety-eight cases of CINIII initially diagnosed by colposcopical biopsy in our hospital from 2000 to 2008 were analyzed retrospectively in terms of the diagnosis, treatment and outcome.

RESULTSAll the patients received cervical conization including 53 with cold knife conization and 45 with LEEP conization. Obvious differences were noted between cervical conization and colposcopical biopsy results in 15 cases (15.3%) diagnosed to be invasive carcinoma. Fifty-two patients received hysterectomy after conization. A significant difference occurred in pathological diagnosis between cervical conization and hysterectomy groups (P<0.01). There were low-grade cervical intraepithelial lesions in most cases of hysterectomy group and only 4 cases had CINIII. Thirty-one patients refused hysterectomy for concerns of fertility or because of a young age and were followed up after conization. One patient with cervical carcinoma in situ experienced recurrence in 3 years and received a second hysterectomy. The other patients including those in hysterectomy group showed no recurrence till now.

CONCLUSIONCervical conization is the golden standard for the diagnosis of CINIII and can not be replaced by colposcopical biopsy. Cervical conization may serve as the primary choice for treatment of CINIII with negative margin, but the patients should be followed up closely after the operation.

Adult ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; pathology ; surgery ; Conization ; methods ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Uterine Cervical Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the therapeutic effect of cervical conization through hysteroscopy in the treatment of cervical intraepithelial neoplasia (CIN) III.

METHODSSeventy-four patients with CIN III underwent cervical conization through hysteroscopy (TCRC group), and 65 received cold knife conization (CKC group). The operating time, volume of blood loss, concordance rate with pathology, recurrence rate, rate of cervix adhesion and pregnancy rate were compared between the two groups.

RESULTSThe operating time, mean blood loss, cure rate, and recurrence rate were 15.1∓3.2 min, 12.5∓1.8 ml, 94.6%, and 5.4% in TCRC group, respectively, as compared with those of 25.8∓3.8 min, 21.6∓2.4 ml, 81.5%, and 18.5% in CKC group, all showing significant differences between the two groups (P<0.05).

CONCLUSIONCompared with CKC, TCRC has such advantages as less blood loss, shorter operating time, more accurate lesion localization, fewer complications, higher cure rate, and lower recurrence rate without significant adverse effect on pregnancy.

Adult ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; surgery ; Female ; Humans ; Hysterectomy ; methods ; Hysteroscopy ; Middle Aged ; Uterine Cervical Neoplasms ; pathology ; surgery

BACKGROUNDConization is being widely accepted for diagnosis and treatment of cervical intraepithelial neoplasia (CIN). There is controversy as to which factors are most predictive of a positive cone margin and the clinical significance of it. We conducted this study to identify the predictive factors and to evaluate the clinical significance of a positive cone margin in CIN III patients.

METHODSA retrospective review was conducted of 207 patients who had undergone conization due to CIN III from January 2003 to December 2005 at Peking Union Medical College Hospital. Of these, 67 had a subsequent hysterectomy. Univariate and multivariate analysis were utilized to define the predictive factors for a positive cone margin, and to compare the pathologic results of conization with subsequent hysterectomy.

RESULTSOne hundred and fifty-one (72.9%) were margin free of CIN I or worse, 37 (17.9%) had CIN lesions close to the margin and 19 (9.2%) had margin involvement. A total of 56 cases (27.1%) had positive cone margins (defined as the presence of CIN at or close to the edge of a cone specimen). Univariate analysis showed that the parity, cytological grade, multi-quadrants of CIN III by punch biopsy, gland involvement, as well as the depth of conization were significant factors correlated with a positive cone margin (P < 0.05). However the age, gravidity, grade of dysplasia in punch biopsy, as well as the cone methods were not significantly correlated (P > 0.05). Multivariate analysis revealed that the cytological grade (OR = 1.92), depth of conization (OR = 2.03), parity (OR = 3.02) and multi-quadrants of CIN III (OR = 4.60) were significant predictors with increased risk for positive margin. The frequency of residual CIN I or worse in hysterectomy specimens was found to be 55.6% (20/36) in patients who were margin free, 71.4% (15/21) in patients with CIN occurring close to margin, and 80.0% (8/10) in patients with margin involvement. The frequency of residual CIN III or worse was found to be 13.9% (5/36), 23.8% (5/21) and 50.0% (5/10) respectively in different groups.

CONCLUSIONSCytological grade, depth of conization, parity and multi-quadrants of CIN III in punch biopsy were significant factors with increased risk in predicting a positive cone margin. Margin status of conization did not mean the presence or absence of CIN, but rather the varied frequency of residual CIN in specimens of subsequent hysterectomy. In view of this fact, it is suggested that the margin status of conization be a valuable surrogate marker for clinical management of CIN III.

Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; surgery ; Cervix Uteri ; pathology ; Conization ; methods ; Female ; Humans ; Hysterectomy ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the feasibility of surgical management for patients with locally advanced carcinomas of uterine cervix after radical radiation therapy who were prone to develop central recurrence.

METHODSThese 40 patients were treated by combined pre-operative radiotherapy with dose at point A of > 70 Gy in 30 patients, 60 approximately 70 Gy in 7, 50 approximately 59 Gy in 2 and 44 Gy in 1. The interval between radiation and surgery was 1 - 6 weeks. Extrafascial hysterectomy was performed in 15 patients, subradical hysterectomy in 23 and radical hysterectomy with pelvic lymphadenectomy in 2 cases.

RESULTSThese patients have been followed up for 1 - 8 years with 2 died of other diseases and 12 died of cancer. Eighteen of the 26 survivors have been followed up for more than 5 years. The 3- and 5-year survival rates were 74.9% and 66.8%. Half of the death occurred within the first year after treatment. The 2-year death rate was 9/12 (75.0%). Three patients suffered from long term complications after the treatment, but all were cured by conservative management.

CONCLUSIONThe combination of hysterectomy performed shortly after radical radiotherapy, ie, for patients with locally poor prognostic cervical carcinoma is reasonable and feasible.

Adult ; Cervix Uteri ; Combined Modality Therapy ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Staging ; Survival Rate ; Uterine Cervical Neoplasms ; mortality ; radiotherapy ; surgery

Adult ; Aged ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; pathology ; surgery ; Conization ; methods ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; pathology ; surgery ; Uterine Cervical Neoplasms ; pathology ; surgery

INTRODUCTION: Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous tumor of low grade malignancy and microscopically resembles lymphoepitheliomatous malignancies in the nasopharynx, palatine tonsils, salivary glands and uterine cervix. LELCS presents as scarlet-colored firm nodules or plaques on the face, scalp, or shoulder of middle-aged to elderly individuals. MATERIAL AND METHODS: A 72 year-old female had complained a papule like lesion with intermittent pruritis on the left temple for 2 years. But the lesion was changed to scarlet-colored firm nodule with ulceration. The mass was diagnosed as LELCS on the biopsy. And to confirm that the mass is not metastatic lymphoepithelioma-like carcinoma from other sites or direct tumor extension from the nasopharynx, selective radiographic and laboratory tests were done carefully. RESULTS: Wide excision was performed with general endotracheal anesthesia. The tumor is composed of island of large epithelial cells surrounded by as dense infiltrate of lymphocytes. Immunohistochemical staining with cytokeratin and epithelial membrane antigen(EMA), the tumor cells were positive reaction for stain. And Epstein-Barr virus genome was not detected by in situ hybridization. So, the tumor was confirmed as LELCS. CONCLUSION: LELCS was described by Swanson at 1988, but has not been reported in the field of plastic surgery of Korea. We report a case of primary LELCS that occurred in the left temple with clinical characteristics, histologic features and references.
Aged ; Anesthesia ; Biopsy ; Cervix Uteri ; Epithelial Cells ; Female ; Genome ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Keratins ; Korea ; Lymphocytes ; Membranes ; Nasopharynx ; Palatine Tonsil ; Pruritus ; Salivary Glands ; Scalp ; Shoulder ; Skin ; Surgery, Plastic ; Ulcer

OBJECTIVETo explore the feasibility and safety of transvaginal external fascia trachelectomy to conservatively treat patients with stage Ia1 squamous carcinoma of the uterine cervix (SCC) and cervical intraepithelial neoplasia (CIN) III, who are not suitable to take cold knife conization (CKC).

METHODSFrom July 2002 to September 2010, those patients who had a strong desire to preserve the uterus or fertility but also are confronted with following situations received transvaginal external fascia trachelectomy: CIN III with large area lesion (colposcopically observed lesion area was larger than 3/4 of the cervix), or patients with CIN II-III suffered recurrence or had persistent lesion or positive margin after CKC or LEEP, or patients with CIN II-III upgraded into stage Ia1 SCC through LEEP and pathological confirmation (except for those with lymphovascular space invasion), or CIN III patients complicated with upper vaginal intraepithelial neoplasia (VAIN). Their clinical information and data were reviewed and analyzed.

RESULTSAmong the 79 cases, who underwent transvaginal external fascia trachelectomy, six were stage Ia1 SCC, 61 were CIN III with a large area lesion (23 cases had glandular involvement), three were CIN III complicated with VAIN, six were CIN III with persistent lesion after LEEP, two were CIN III with positive margins after LEEP, and one case had recurrence after conization. The median age of these patients was 33 years old, ranging from 23 to 40 years old. The mean operation time was 39 min (rang 20-60 min), the average amount of bleeding was 40 ml (rang 1-300 ml) and the mean hospital stay was 10 d ( rang 6-17 d). The CIN III patients complicated with VAIN received this surgery with resection of the adjacent vaginal mucosa more than 2 cm in 3.8% (3/79). The median follow-up time was 49 months (8-85 months) and none of these patients had ureteral injury or large amount of intraoperative or postoperative bleeding or post-operative recurrence. No patient complained any effect on their sexual life. Among the five patients with reproductive desire, one was at her 22 w gestation after one induced abortion and one spontaneous abortion, four patients experienced term birth in which three were cesarean section and one was natural labour.

CONCLUSIONSTransvaginal external fascia trachelectomy is a safe and effective conservative treatment for stage Ia1 SCC, CIN III with large area lesion, CIN III complicated with VAIN and CIN II-III suffering recurrence, persistent lesion or positive margins after CKC and others that are not suitable to take CKC.

Adult ; Carcinoma, Squamous Cell ; pathology ; surgery ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; surgery ; Female ; Fertility Preservation ; Follow-Up Studies ; Gynecologic Surgical Procedures ; methods ; Humans ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Organ Sparing Treatments ; methods ; Uterine Cervical Neoplasms ; pathology ; surgery ; Young Adult