Recurrent invasive adenocarcinoma after hysterectomy for cervical adenocarcinoma in situ

Background. Unlike its squamous counterpart, therapy for cervical adenocarc inoma in situ with positive endocervical cone margin remains controversial. Case. A 52-year-old gravida 2, para 1,0,1,1, presented with vaginal bleedin g. Gynecologic history was significant for cervical fold knife conization w ith a positive endocervical margin and endocervical curettage with atypical endocervical cells. Repeat cone biopsy was considered unsafe given the lar ge initial cone specimen. An extrafascial hysterectomy was performed 5 week s later and pathology confirmed a disease-free cervix. Pap smear performed 1 year later was interpreted as recurrent adenocarcinoma but later downgrad ed to inflammation. Inspection and random biopsies of the vaginal cuff reve aled only inflammation. Two subsequent Pap smears also returned inflammatio n. Seventeen months after the hysterectomy physical examination revealed a 2 x 3-cm smooth mass at the vaginal cuff. Biopsy revealed invasive adenocar cinoma. The patient underwent an upper vaginectomy followed by postoperativ e pelvic radiation. Conclusion. This case suggests that despite extrafascial hysterectomy for p resumed adenocarcinoma in situ of the cervix, a residual focus could remain and present later as invasive adenocarcinoma. (C) 2000 Academic Press.