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Full length article| Volume 264, P56-59, September 2021

Invasive cervical cancer following treatment of pre-invasive lesions: A potential theory based on a small case series

Published:July 02, 2021DOI:https://doi.org/10.1016/j.ejogrb.2021.06.049
Invasive cervical cancer following treatment of pre-invasive lesions: A potential theory based on a small case series
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      Abstract

      Purpose

      The aim of this study is to present a single department’s experience on cervical cancer cases following previous excision of cervical intraepithelial neoplasia (CIN) and to discuss potential pathogenesis.

      Methods

      Nine cervical cancer cases meeting the inclusion criteria, with available pathological and follow-up data, were considered eligible for this study.

      Results

      The majority (7/9) have had clear excisional margins. The interval between initial treatment and cancer diagnosis ranged from 7 to 17 years. In all cases cancer diagnosis was “unexpected”, as the prior cytological and/or colposcopic evaluation was not suggestive of significant cervical pathology. All cancers were squamous, and 5/9 at stage I.

      Conclusion

      The long interval between initial CIN treatment and final diagnosis as well as the normal post-treatment follow-up may suggest a ‘de novo’ underlying but ‘hidden’ carcinogenesis process. It might be that dysplastic cells entrapped within crypts (or normal metaplastic affected by the same predisposing factors) continue undergoing their evolution, undetectable by cytology and colposcopy until they invade stroma and surfaces (endo- and/or ectocervical) approximately a decade later. Heavy cauterisation of cervical crater produced post excision might be a potential culprit of this entrapment.

      Keywords

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      Article info

      Publication history

      Published online: July 02, 2021
      Accepted: June 30, 2021
      Received in revised form: June 23, 2021
      Received: May 22, 2021

      Identification

      DOI: https://doi.org/10.1016/j.ejogrb.2021.06.049

      Copyright

      © 2021 Elsevier B.V. All rights reserved.

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