Prognostic Factors Influencing Decisions About Surgical Treatment of Villoglandular Adenocarcinoma of the Uterine Cervix

A Retrospective Study and Literature Review of Cervical Villoglandular Adenocarcinoma: A Candidate Paradigm of Silva System Pattern A

The aim was to investigate the clinicopathologic characters of cervical villoglandular adenocarcinoma (VGA), the authors retrospectively reviewed 4 cases of VGA, including clinical characteristics, pathology, managements, together with outcome information. The median age of the patients was 42 (range: 37 to 58), with 3 of them presenting with stage IB disease and 1 presenting with IVB. Human papillomavirus infection was tested in 3 of the patients, with all positive with high-risk type. Three of the patients underwent a radical hysterectomy with bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, and 2 of them underwent subsequent chemotherapy. One patient received a bilateral salpingo-oophorectomy plus pelvic and periaortic lymphadenectomy and postoperative radiochemotherapy. Lymph node metastasis was detected in 1 patient. The follow-up time ranged from 56 to 120 months (median: 70 mo). Except for 1 person who experienced recurrence, all patients are alive at present and no recurrence occurred. In conclusion, VGA is a rare subtype of adenocarcinoma of the uterine cervix with distinct exophytic, villous-papillary growth pattern and extremely excellent prognosis, which corresponds with pattern A in Silva system, while its underlying mechanism and genetic background is still far from well known.

Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis

Purpose

Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer.

In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib₁ VGA.

Methods

Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia–Ib₁).

Results

A total of 271 patients were included in our literature review. 54 (20%) patients were treated by “conservative management” (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by “invasive management” (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA.

Conclusion

The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.

Clinical features and prognostic factors of cervical villoglandular adenocarcinoma

BACKGROUND

Villoglandular adenocarcinoma is a rare sub-type of cervical adenocarcinoma.

OBJECTIVE

To analyze the clinicopathological features and evaluate the prognosis of patients with villoglandular adenocarcinoma of the cervix.

METHODS

Patient characteristics, procedure, pathology, and surgical outcomes were retrospectively reviewed in patients with villoglandular adenocarcinoma between November 2006 and June 2019 from multiple centers in China. In order to explore the difference between villoglandular adenocarcinoma and routine adenocarcinoma, patients (FIGO 2009 stage IA1-IB2) who had complete data during the same time period were included.

RESULTS

A total of 60 patients with villoglandular adenocarcinoma and 104 with standard adenocarcinoma were included. The median age of the patients with villoglandular adenocarcinoma was 42 years (range 27-68). The most common 2009 FIGO stage was IB1 in 39 (65%) patients with villoglandular adenocarcinoma. A total of 23 patients underwent laparoscopic surgery (two total hysterectomies, 21 radical hysterectomies) and the other 37 patients underwent laparotomy (three total hysterectomies, 34 radical hysterectomies). A total of 56 patients underwent lymphadenectomy and three (5.4%) had positive lymph nodes. Fifteen (25%) patients had one or both ovaries preserved. Seven patients were lost to follow-up. The median follow-up time for the entire group was 50.2 months (range 5.1-154.6). No deaths or recurrences occurred. Excluding six patients with FIGO 2009 stage II, the 5-year disease-free survival of the 47 patients with villoglandular adenocarcinoma with FIGO 2009 stage I for whom there was follow-up, was significantly higher than that of the 104 patients with standard cervical adenocarcinoma (100% vs 92.2%, log-rank p=0.039). However, the 5-year overall survival of the two groups did not differ (100% vs 95.7%, log-rank p=0.11).

CONCLUSION

Villoglandular adenocarcinoma has a favorable prognosis. Further studies are needed to provide more details of treatment strategies and prognosis.

Villoglandular adenocarcinoma of cervix: pathologic features, clinical management, and outcome

Background

The objective of the study was to investigate the management and prognosis of patients with villoglandular adenocarcinoma (VGA) of the uterine cervix.

Materials and methods

The clinical presentation, pathology, management, and prognosis of 41 patients with VGA or other types of cervical adenocarcinoma (ADC) were retrospectively reviewed.

Results

During the patient follow-up period, the proportion of VGA was 8.1% in the cervical ADC cohort (41/507). The median age of the patients with VGA was 41.0 years. The most common presenting symptom was cervical contactive bleeding. There were 38 patients classified as FIGO stage IA1-IB. The median follow-up period was 38.5 months. There were no patient deaths, and only one patient showed recurrence. One of the patients delivered a healthy baby at 34 weeks of gestation prior to treatment with radical hysterectomy. The HPV HC2 test results showed that most patients were positive for HPV infection. HPV 16, 18, and 56 were positive in the 8 patients with HPV type test results. There were significant differences in the grade, depth of stromal invasion, lymph node metastasis, and recurrence between the VGA cases of FIGO stage I and the other types of cervical ADC of FIGO stage I (p<0.05).

Conclusion

This study confirmed that VGA is a type of well-differentiated cervical cancer characterized by shallow stromal invasion, less lymph node metastasis. VGA is associated with less recurrence than other types of cervical ADC.

Study of the revisited, revised, and expanded Silva pattern system for Chinese endocervical adenocarcinoma patients

As a new pattern-based classification, the Silva pattern system has been recently developed to evaluate invasive lymph node metastasis and the prognosis of endocervical adenocarcinoma (EAC). Therefore, our study was conducted to explore the reproducibility and prognostic significance of this system in a multi-institutional Chinese cohort, with the goal of revising and expanding its application. The clinicopathological data of 191 EAC patients from 3 medical centers were examined in a retrospective manner. The Silva pattern system demonstrated great prognostic value, significance in guiding treatment selection, and acceptable reproducibility in 191 patients that included additional histologic variants and 124 usual-type EAC patients. Collectively, compared with usual-type EAC, the whole cohort demonstrated similar statistical significance for relevant clinicopathological parameters, such as International Federation of Gynecology and Obstetrics stage (R = 0.612 versus R = 0.600), tumor thickness (P < .0001 versus P < .0001), lymphovascular invasion (P < .0001 versus P < .0001), lymph node metastasis (P = .033 versus P = .018), perineural invasion (P = .003 versus P = .001), and recurrence-free survival (P = .047 versus P = .020). Moreover, perineural invasion was significantly correlated (P = .001) with the Silva pattern system and appeared in most Silva C tumors. In conclusion, the Silva pattern system is consistent with the biological behavior of EAC and has acceptable reproducibility. Compared with International Federation of Gynecology and Obstetrics stage, it can predict patient prognosis before surgery. We suggest revising the Silva C criteria by adding perineural invasion as a factor and propose expanding the Silva pattern system to include more histologic variants. It seems that the Silva pattern system can be applied in routine clinical practice to guide EAC therapeutic strategies in the near future.

Association between expression of MMP-7 and MMP-9 and pelvic lymph node and para-aortic lymph node metastasis in early cervical cancer

AIMS

To investigate the association of matrix metalloproteinase (MMP)-7 and MMP-9 with pelvic lymph node and para-aortic lymph node metastasis in early cervical cancer.

METHODS

A total of 137 patients with early cervical cancer (Stage Ia2-IIa2) were recruited from the Department of Gynecology and Obstetrics, Tumor Hospital of Liaoning Province from January 2009 to May 2014. We evaluated the expression of MMP-7 and MMP-9 by immunohistochemistry and their association with the clinicopathological parameters such as pelvic, common iliac and para-aortic lymph node metastasis. Spearman correlation was performed to analyze the correlation between MMP-7 and MMP-9 in cervical cancer. Finally, the areas under the receiver operating characteristic curve (ROC) of MMP-7 and MMP-9 in pelvic lymph node metastasis were assessed.

RESULTS

MMP-7 expression was significantly higher in patients with adenocarcinomas and adenosquamous carcinomas (P = 0.014), vascular cancer embolus (P = 0.041), pelvic lymph node metastasis (P = 0.000) and a higher level of Ki-67 (P = 0.000). MMP-9 expression was significantly associated with vascular cancer embolus (P = 0.003), depth of stromal invasion (P = 0.001), pelvic lymph node metastasis (P = 0.003), common iliac lymph node metastasis (P = 0.001) and para-aortic lymph nodes metastasis (P = 0.004). Coexpression of MMP-7 and MMP-9 was significantly associated with vascular cancer embolus (P < 0.001), higher expression of Ki-67 (P < 0.001) and pelvic lymph node metastasis (P < 0.001). Spearman correlation analysis indicated a positive correlation between MMP-7 and MMP-9 (r = 0.263, P = 0.002). Areas under the ROC of MMP-7 and MMP-9 were 0.707 and 0.646, respectively.

CONCLUSION

MMP-7 and MMP-9 expressions were associated with lymph node metastasis in patients with early cervical cancers, suggesting a positive correlation of MMP-7 and MMP-9 with invasive potential in early cervical cancers.

Is the ovarian preservation safe in young women with stages IB-IIA villoglandular adenocarcinoma of the uterine cervix?

Objective

Because villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA.

Methods

We retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015.

Results

This study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa.

Conclusion

This study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.

Association of CXCR4, CCR7, VEGF-C and VEGF-D expression with lymph node metastasis in patients with cervical cancer

OBJECTIVE

We attempted to investigate the expression of CXCR4, CCR7, VEGF-C and VEGF-D in cervical cancer specimens, and the association between CXCR4, CCR7, VEGF-C and VEGF-D expression with the clinicopathological parameters of patients with cervical cancer.

STUDY DESIGN

57 tissue microarrays including 9 normal cervical tissues and 48 cervical cancer tissues were purchased from Biomax. The association between CXCR4, CCR7, VEGF-C and VEGF-D expression with the clinicopathological parameters were evaluated. Then immunohistochemistry was used to assess the expression of CXCR4, CCR7, VEGF-C and VEGF-D in cervical cancer specimens. Finally, Spearman correlations were used for the correlation analyses between CXCR4, CCR7, VEGF-C and VEGF-D.

RESULTS

We revealed that CXCR4 expression was significantly higher in patients with squamous cell carcinomas (P=0.002) and lymph node metastasis (P=0.038), while CCR7 expression was significantly elevated in patients with lymph node metastasis (P=0.037). VEGF-C expression was markedly up-regulated in patients exhibiting FIGO stage II-III tumors (P=0.015) and lymph node metastasis (P=0.038), while VEGF-D expression was obviously increased in patients displaying FIGO stage II-III tumors (P=0.025), squamous carcinomas (P=0.017) and lymph node metastasis (P=0.037). The correlation analysis indicated that CXCR4, CCR7, VEGF-C and VEGF-D expression have a significant correlation to each other.

CONCLUSION

These results suggested that CXCR4, CCR7, VEGF-C and VEGF-D expression might have synergistic effects on the lymph node metastasis in patients with cervical cancer.

A retrospective review of 11 cases of villoglandular papillary adenocarcinoma of the uterine cervix and a review of the literature

Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a rare subtype of cervical adenocarcinoma (AC) that accounts for 3.7-4.8% of cervical AC. Compared with ordinary adenocarcinoma, VGPA is associated with a lower incidence, younger age and better prognosis. Treatment with fertility-preserving surgery is also possible. The present study analyzed cases treated in The Second Hospital of Jilin University (Changchun, Jilin, China) between January 2010 and December 2014. A total of 11 cases were selected; of these, 7 cases were pathologically confirmed. The remaining 4 cases were diagnosed as VGPA upon the pathological examination of the biopsy, but confirmed as another type of adenocarcinoma upon analysis of the surgical pathology. The median age of the patients whose pathology was confirmed post-operatively was 36 years, and all cases were positive for human papillomavirus (HPV). As all 7 patients had no requirement for further fertility, a radical hysterectomy was performed, with or without adjuvant therapy. The follow-up time ranged from 7-57 months, with a mean time of 29 months. There was no evidence of recurrence in any of the patients. All the patients remain alive to date. The results of the present study indicated that HPV infection is likely to be the cause of VGPA, and the prognosis of VGPA tends to be better compared with other types of adenocarcinoma. However, the number of studies that have reported cases of VGPA remains small, and all are retrospective analyses with short follow-up times. Therefore, physicians selecting treatment options for patients with VGPA should exercise caution.