Early invasive adenocarcinoma of the uterine cervix

In an attempt to determine the natural history of early invasive adenocarci noma of the cervix, defined as depth of invasion of 5 mm or less, an extens ive review of the literature was undertaken, together with recent unpublish ed material of the author. Many of the cases had to be extracted from serie s dealing with microinvasive squamous cell carcinoma. The pens asinorum(a) for the pathologist is the differentiation between adenocarcinoma in situ a nd early invasion. The criteria for microinvasion are: 1.) obvious invasion to 5 mm or less; 2.) usually complete obliteration of the normal endocervi cal crypts; 3.) extension beyond the normal glandular field; and 4.) a stro mal response characteristic of invasive carcinoma. Not all of these criteri a are present in every case. In all 436 cases were collected. Allowing for vagueness of reports, 126 patients were treated by radical hysterectomy, an d none had parametrial involvement. No cases of adnexal tumors were found i n the 155 patients in whom one or both ovaries were removed. Of the 219 pat ients with pelvic lymph node dissection, five (2%) had metastasis. There we re 15 recurrences and six tumor-related deaths in the 436 patients. Only 21 patients had conization as the only treatment, and none has suffered a rec urrence. It appears that early invasive adenocarcinoma behaves in the same way as its squamous counterpart. Cold knife conization is acceptable treatm ent only when the cone biopsy has been adequately sampled and the margins a re free, especially when preservation of fertility is an issue. Loop excisi on procedures obscure depth of invasion and margins and are not acceptable either for diagnosis or therapy. Multicentricity does not appear to require cylindrical cones. If hysterectomy is contemplated, removal of the adnexa, per se, is unnecessary.