Relation of cervical glandular intraepithelial neoplasia to microinvasive and invasive adenocarcinoma of the uterine cervix: a study of 121 cases

Aims -To examine the relation between invasive adenocarcinoma and its alleg ed precursor, cervical glandular intraepithelial neoplasia (CGIN), and to a ssess the management and outcome of CGIN and the validity of using the term ''microinvasive adenocarcinoma." Methods-The clinical and pathological features of 121 cases of glandular ne oplasia of the cervix diagnosed between the years 1990 to 1995 were examine d for the following: histological diagnosis, smear records, type of treatme nt, the association between the precursor lesions and invasive disease, and follow up. Results-27 cases were identified as low grade CGIN (L-CGIN) and 38 as high grade CGIN (H-CGIN), 10 as microinvasive adenocarcinoma (less than 5 mm in depth), and 46 as invasive adenocarcinoma. The ratio of non- invasive to in vasive disease was 1.12:1. The mean age of women was 39, 43, 43, and 48 yea rs for L-CGIN, H-CGIN, microinvasive, and invasive adenocarcinoma, respecti vely. L-CGIN was seen in 13% and 18% of H-CGIN and microinvasive disease, r espectively. H-CGIN was seen in 100% of microinvasive and 26% of invasive a denocarcinomas. The available smears before diagnosis predicted 59% of L-CG IN, 70% of H-CIGN, 100% of microinvasive adenocarcinoma, and 32% of invasiv e adenocarcinomas. Treatment of 74% of L-CGIN, 52% of H-CIGN, and 10% of mi croinvasive adenocarcinoma was by diathermy loop excision only. The remaini ng cases had hysterectomy. Residual disease was found in 43%, 50%, and 33% of hysterectomies for L-CGIN, H-CGIN, and microinvasive adenocarcinoma, res pectively. This is correlated with positive margins, or disease within 3 mm of margins on loop specimens. Cervical smear follow up for two to seven ye ars revealed no recurrence of glandular lesions in any of the cases of CGIN or microinvasive adenocarcinoma. Conclusions-Precursor glandular lesions tend to progress to invasive carcin oma. There is a progressive increase in age of patients from L-CGIN to inva sive disease, a span of approximately 10 years. There is a high association between H-CGIN and invasive disease. In the management of such alleged pre cursors, it is important to ensure adequate free margins of at least 3 mm. Microinvasive adenocarcinoma appears to have an excellent prognosis if trea ted by hysterectomy.