Clear cell carcinoma of the uterine cervix: Pathology and prognosis in surgically treated stage IB-IIB disease in women not exposed in utero to diethylstilbestrol

Objective. The purpose of this research was to compare the clinical behavio r, pathology findings, and prognosis of surgically treated FIGO stage IB-II B clear cell carcinomas of the cervix with those of squamous cell carcinoma s and non-clear cell adenocarcinomas. Methods. Fifteen patients with clear cell adenocarcinomas of the cervix (8 FIGO stage IB, 7 FIGO stage IIB) were reviewed. The control group consisted of 444 squamous cell carcinomas and 59 non-clear cell adenocarcinomas. Non e of the patients had a history of in utero exposure to diethylstilbestrol. All patients underwent radical abdominal hysterectomy with systematic pelv ic lymphadenectomy. All specimens were processed as serial giant frontal se ctions. The mean follow-up in the clear cell group was 83 (13-182) months. Statistical analysis was done with contingency tables, chi(2) tests, and Fi sher's exact test. Results. Twelve of the fifteen clear cell carcinomas (80%) were endophytic and tended toward deep cervical infiltration. Clear cell carcinomas extende d to the uterine corpus significantly more often than squamous cell and non -clear cell adenocarcarcinomas (P < 0.001). The rates of parametrial involv ement and pelvic lymph node involvement were 40 and 47%, respectively. Four patients (27%), all with positive pelvic nodes, developed recurrences an a verage of 14 (4-48) months after initial therapy. The extrapelvic sites of relapse were the lung, liver, and bone. Clear cell carcinomas had a worse 5 -year survival rate (67%) than squamous cell carcinomas (80%) and non-clear cell adenocarcinomas (77%) but this was not statistically significant (P = 0.6). No significant differences were seen for age, growth pattern, parame trial and vaginal involvement, parametrial and pelvic lymph node metastases , frequency of recurrent disease, and time to first recurrence. Conclusion. The clinicopathologic findings and prognosis of surgically trea ted patients with stage IB-IIB clear cell carcinomas without exposure to di ethylstilbestrol in utero are similar to those of patients with squamous ce ll carcinomas and non-clear cell adenocarcinomas. (C) 2000 Academic Press.