Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment

BACKGROUND

Cervical carcinoma diagnosed during pregnancy generates conflicting concerns between control of malignancy and continuation of pregnancy.

CASE

An invasive cervical carcinoma FIGO Stage IB2 was diagnosed in a 33-year-old primigravida during the first trimester of pregnancy. Because the patient strongly desired to preserve her pregnancy, laparoscopic lymphadenectomy was performed at 16 weeks of gestation to determine the extension of disease. Negative lymph node status was found and the patient was counseled about the possibility of proceeding until adequate fetal maturity had been achieved. An elective cesarean section and radical hysterectomy were performed at 36 weeks, followed by postoperative chemoradiation therapy. The clinical and Pap smear follow-up remain normal after four years.

CONCLUSION

Pregnant women diagnosed with early stage cervical carcinoma should receive a complete evaluation including lymphadenectomy before considering delayed therapy. This strategy seems to be an acceptable option in well-defined conditions, and offers these patients the possibility of maternity.

CytoRich liquid-based cervical cytologic test. Screening results in a routine cytopathology service

OBJECTIVE

To eliminate the disadvantages and inherent bias of split-sample studies by evaluating the relative performance of monolayers and conventional cervical cytologic smears in a single laboratory through evaluation of two large and similar, randomly derived patient groups from the same geographical and demographically similar population.

STUDY DESIGN

Two randomly created large patient groups from the same population were evaluated using conventional microscopic screening. One group was tested using the conventional smear. The other was evaluated using only the new liquid-preservative-based CytoRich preparation (AutoCyte, Inc., Elon College, North Carolina, U.S.A.) with the intended direct-tovial cell collection method. Results were then compared statistically as to disease detection and sample adequacy.

RESULTS

Age comparisons between the two groups demonstrated equivalency. Specimen adequacy was greatly improved in the group tested with the CytoRich monolayer preparation. The monolayer group also demonstrated a significant reduction in ambiguous atypical squamous cells of undetermined significance/atypical glandular cells of undetermined significance diagnoses and a threefold increase in the detection of squamous intraepithelial lesion and cancer.

CONCLUSION

Routine use of homogeneous monolayer preparations as a total replacement for the conventional smear can be expected to dramatically improve specimen adequacy and sensitivity of the conventional smear alone. Direct-to-vial use of the new monolayer preparation generated significantly better results than those shown in any of the earlier split-sample trials.

Acetic acid visualization of the cervix: an alternative to cytologic screening

OBJECTIVE

To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening.

METHODS

A prospective study was conducted in a squatter area in Cape Town, South Africa, on 2426 women who underwent speculum examination, naked-eye inspection of the cervix after application of acetic acid, and cytologic smear. The smears were stained and processed at the screening site. Patients with a positive reading after acetic acid or a smear indicating a high-grade squamous intraepithelial lesion (SIL) were referred for immediate colposcopy, biopsy, and when indicated, treatment by large loop excision of the transformation zone. Therefore, histology was obtained on all patients with a positive acetic acid test or a positive cytology.

RESULTS

Seventy-six women with positive reactions to acetic acid. Among the 2350 women with negative reactions, 254 had positive cervical smears; only 11 of these had histologic high-grade SIL. In contrast, 20 of the 61 women with positive cytology and positive acetic acid test had high-grade SIL on histology. Therefore, the acetic acid reaction enabled the observer to detect 20 of the 31 women (64%) who exhibited a high-grade SIL both on cytology and histology.

CONCLUSION

In locations where access to cytopathology is limited, naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions.

Can cervical cancer be prevented by a see, screen, and treat program? A pilot study

OBJECTIVE

Our purpose was to determine the feasibility of providing a cervical screening facility to the underprivileged communities through an educational program and a mobile clinic in which cytologic smears could be taken, screened immediately, and, when appropriate, the patients treated on site with minimal delay.

STUDY DESIGN

A prospective study was conducted in two parts on 5045 patients living in squatter areas around Cape Town, South Africa. The patients were educated about cervical cancer and its prevention and were offered a free Papanicolaou smear taken in a fully equipped mobile clinic. These were immediately stained and processed. Patients diagnosed cytologically as having high-grade squamous intraepithelial lesions were assessed colposcopically and, when indicated, immediately treated by large loop excision of the transformation zone under local anesthesia.

RESULTS

In phase 1, colposcopy was done in the nearest colposcopy clinic, 20 km from the screening site. The defaulter rate was 66%. In phase 2, colposcopy and treatment were offered on site. A total of 97% of patients referred for colposcopy attended the clinic, and all patients requiring treatment have been adequately treated.

CONCLUSION

With a rapid turnaround time for the reporting of cytologic results and given a colposcopy and treatment facility available located at the screening site at the time women receive their results, the majority of women will undergo colposcopy and treatment.

Placental site trophoblastic tumor: three case reports and literature review

The clinical features of three patients with placental site trophoblastic tumour (PSTT) are presented. Two patients had probable nephrotic syndrome, which was unrecognized at the time. The nephrotic syndrome disappeared after hysterectomy in one patient and the other demised after one cycle of chemotherapy. The use of hysteroscopy in one patient and the management of a pulmonary metastasis in another are described.