Management of Adenocarcinoma In Situ of Cervix in Pregnancy
AbstractAdenocarcinoma in situ is one of the premalignant lesions of the cervix and its incidence is believed to be increasing while the pathogenesis of the disease is not clearly understood. Management of Adenocarcinoma in situ (AIS) unlike carcinoma in situ (CIS) has not been clearly described in the current literature. Here we describe conservative management and serial olposcopy of two pregnant women with adenocarcinoma in situ of the cervix. Both of the cases were diagnosed initially with abnormal Pap smears and were confirmed by colposcopic directed biopsy. None of the patients agreed with any invasive procedure during pregnancy and both of them were followed with serial colposcopy. None of the lesions showed any evidence of progression. All cases underwent cold knife cone biopsies in their postpartum period. Hysterectomy as the final treatment has been done in both cases with no evidence of progression of the disease during pregnancy. We concluded that adenocarcinoma in situ of the cervix during pregnancy could be managed conservatively with definite treatment postponed till after delivery.
Hepler TK, Dockerty MB, Randall LM. Primary adenocarcinoma of the cervix. Am J Obstet Gynecol 1952;63:800–8.
Friedell GH, McKay DG. Adenocarcinoma in situ of the uterine cervix. Cancer 1953;6:887–97.
Wright TC, Richart RM. Pathogenesis and diagnosis of preinvasive lesions of the lower genital tract. In: Hoskins WJ, Perez CA, Young RC, eds. Principles and Practice of Gynecologic Oncology, 2nd Ed. New York: Lippincott-Raven,1997:675–715.
Wright TC, Kurman RJ, Ferenczy A. Precancerous lesions of the cervix. In: Kurman RJ, eds. Blausteins Pathology of the Female Genital Tract, 4th ed. New York: Lippincott-Raven, 1994:229–77.
Widrich T, Kennedy AW, Myers TM, Hart WR, Wirth S. Adenocarcinoma in situ of the uterine cervix: Management and outcome. Gynecol Oncol 1996;61:304–8.
Ursin G, Peters RK, Henderson BE, d'Ablaing G 3rd, Monroe KR, Pike MC. Oral contraceptive use and adenocarcinoma of the cervix. Lancet 1994; 344: 1390–4.
Anderson ES, Arffmann E. Adenocarcinoma in situ of the uterine cervix: A clinico-pathologic study of 36 cases. Gynecol Oncol 1989; 35: 1–7.
Krivak TC, Retherford B, Voskuil S, Rose GS, Alagoz T. Recurrent invasive adenocarcinoma after definitive therapy for cervical adenocarcinoma in situ. Gynecol Oncol 2000;77:334–5.
Krivak TC, Rose GS, McBroom JW, Carlson JW, Winter WE. III, Kost ER. Cervical Adenocarcinoma in Situ: A Systematic Review of Therapeutic Options and Predictors of Persistent or Recurrent Disease. OB GYN Survey 2001;56:567-75.
Griffin D, Manuck TA, Hoffman MS. Adenocarcinoma in situ of the cervix in pregnancy. Gynecol Oncol 2005;97:662-4.
Poynor EA, Barakat RR, Hoskins WJ. Management and follow-up of patients with adenocarcinoma in situ of the uterine cervix. Gynecol Oncol 1995;57:158–64.
Hocking GR, Hayman JA, Ostor AG. Adenocarcinoma in situ of the uterine cervix progressing to invasive adenocarcinoma. Aust N Z J Obstet Gynaecol 1996;36:218–20.
Wolf JK, Levenbeck C, Malpacia A, Morris M, Burke T, Mitchell ML. Adenocarcinoma in situ of the cervix: Significance of cone biopsy margins. Obstet Gynecol 1996;88:82–6.
Im DD, Duska LR, Rosenshein NB. Adequacy of conization margins in adenocarcinoma in situ of the cervix as a predictor of residual disease. Gynecol Oncol 1995;59:179–82.
Azodi M, Chambers SK, Rutherford TJ, Kohorn EI, Schwartz PE, Chambers JT. Adenocarcinoma in situ of the cervix: Management and outcome. Gynecol Oncol 1999;73:348–53.
Shin CH, Schorge JO, Lee KR, Sheets EE. Conservative management of adenocarcinoma in situ of the cervix. Gynecol Oncol 2000;79:6–10.
Ostor AG, Duncan A, Quinn M, Rome R. denocarcinoma in situ of the uterine cervix: An experience with 100 cases. Gynecol Oncol 2000;79:207–10.