Cervical neoplasia and gland openings

Colposcopy for gland (crypt) openings

Systematic observation of the gland(crypt) openings of the uterine cervix is essential to colposcopy.

Adenocarcinoma in situ of the uterine cervix: a clinico-pathologic study of 36 cases

Thirty-six consecutive cases of adenocarcinoma in situ (ACIS) of the uterine cervix, including 8 cases of early stromal invasion to a depth not exceeding 5 mm, were revised with specific reference to detection rate and treatment. The final histologic diagnoses were based on 31 cone biopsies, 1 hysterectomy specimen, and 4 endocervical curettings/punch biopsies. ACIS was localized in the transformation zone of all cone biopsies/hysterectomy specimen, with a mostly superficial spread in the glands. The mucosal surface was involved in 34 cases. In 29 cone biopsies, ACIS was found unifocal. ACIS was associated with lesions of the squamous epithelium, mostly severe, in 25 cases. On review, all cervical smears were positive and ACIS could be specifically diagnosed in 24 cases. Pretreatment biopsies showed ACIS in 28 cases. Detection of early invasive adenocarcinoma required cone biopsy in most cases. Colposcopy showed no characteristics of ACIS. The detection of ACIS depended on the extension of the lesion. Conization with uninvolved margins was an adequate treatment. Residual ACIS was only found in cases with coexisting early invasive adenocarcinoma. No recurrences or frankly invasive adenocarcinomas have been observed during the observation period.

Colposcopic findings of gland openings in cervical carcinoma: their histological backgrounds

During the past 8 years 1501 colposcopies were performed paying a special attention to cervical glands for diagnosis of cervical intraepithelial neoplasia (CIN) and carcinoma. Normal openings could exclude these diseases at the error rate of only 5.1%, while atypical openings could identify them at the high confidence rate of 96.3%. False positive evaluations were mostly attributable to a marked degree of squamous metaplasia in the glands. The absence of gland openings in the main portion of the lesions amounted to 88.6% in invasive carcinomas but to only 12.4% in CIN. Adenoma malignum was a highly characteristic exception.

Early stage adenocarcinoma of the uterine cervix. Histopathologic analysis with consideration of histogenesis

Thirty cases of early stage adenocarcinoma, 5 mm or less in depth, were selected from 1942 primary carcinomas of the uterine cervix for histologic analysis to clarify their histogenesis. There were 16 carcinomas of endocervical type, 12 of endometrioid type, and 2 clear cell carcinomas. There were 22 early invasive adenocarcinomas and 8 adenocarcinomas in situ. In 27 cases the carcinoma was adjacent to the transformation zone and in 3 it was separate from it. In 10 cases adenocarcinoma coexisted with in situ squamous cell carcinoma. Only one patient whose tumor was 3 mm in depth developed a pelvic recurrence after radical hysterectomy. All other patients remained disease-free after treatment by hysterectomy. It is suggested that most adenocarcinomas of the uterine cervix originate from endocervical glands adjoining the transformation zone and that they may develop directly from normal-appearing epithelium without passing through adenomatous or dysplastic changes.

Colposcopy for postmenopausal women

The number of postmenopausal women colposcopically diagnosed has markedly increased during the last 15 years. In some of them, a clear colposcopic impression, required for planning an appropriate therapy, was disturbed by severe senile cervicocolpitis, when examined by the conventional technique using acetic acid. With a 5-year experience of 79 paired colposcopies, it was concluded that estrogen administration is necessary as a routine precolposcopic procedure in such cases and oral administration of conjugated estrogens at 1.25 mg/day for 14 days is adequate for this purpose.