Adenocarcinoma of the Uterine Cervix and its Precursor Lesion

__Abstract__ More than 2000 years have elapsed since the first description of cervical cancer by Hippocrates. Aretaeus, an ancient Greek physician practicing in the first century before Christ, described uterine cancer as superficial and deep ulcers, which later infiltrate the uterus1 • In 1812 John Clarke described a peculiar degeneration of the cervix, which he called a cauliflower tumor because of it's appearance2• Charles Mansneld Clarke introduced the term carcinoma uteri in 1821 and Hooper identified the cauliflower as a carcinoma of the cervix in 18323. Initia lly there was no distinction between cervical and endometrial carcinoma. Adenoma malignum was used for highly differentiated glandular carcinomas, without distinction in origin. When it became clear that cervical cancer was a separate entity, different types of cervical cancer were described. In German literature Portiokarzinom (karzinom der ektocervix, squamous cell carcinoma origi nating from the portio vaginalis) and Zervixhohlenkarzinom (karzinom der endocervix, adenocarcinoma arizing from the cervical channei)H were dist inguished. Ruge and Veit 1881 and later the school of Schroeder different iated between a portio carcinoma, arising from the connective tissue oft he cervix or from columnar epithelial erosions and cervical carcinoma arising from de cervical glands or from the connective tissue. Treub in 1892 proposed another classification, based on the extension of the different tumor types. He described t he carcinoma of the cervix, also called cancroid or epithelioma as a cancer which originated from the squamous epithelium of the portio vaginalis and the 'Zervixcarcinoma' (cervical cancer) which originated from the cervical glands8 . Today, we speak of cervical carcinoma, without differentiating between portio and cervical cancer

Loss of skeletal muscle density during neoadjuvant chemotherapy in older women with advanced stage ovarian cancer is associated with postoperative complications

Objective: To assess the association between loss of lumbar skeletal muscle mass and density during neoadjuvant chemotherapy (NACT) and postoperative complications after interval cytoreductive surgery (CRS) in older patients with ovarian cancer. Materials and methods: This multicenter, retrospective cohort study included patients aged 70 years and older with primary advanced stage ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), treated with NACT and interval CRS. Skeletal muscle mass and density were retrospectively assessed using Skeletal Muscle Index (SMI) and Muscle Attenuation (MA) on routinely made Computed Tomography scans before and after NACT. Loss of skeletal muscle mass or density was defined as >2% decrease per 100 days in SMI or MA during NACT. Results: In total, 111 patients were included. Loss of skeletal muscle density during NACT was associated with developing any postoperative complication ≤30 days after interval CRS both in univariable (Odds Ratio (OR) 3.69; 95% Confidence Interval (CI) 1.57–8.68) and in multivariable analysis adjusted for functional impairment and WHO performance status (OR 3.62; 95%CI 1.27–10.25). Loss of skeletal muscle density was also associated with infectious complications (OR 3.67; 95%CI 1.42–9.52) and unintended discontinuation of adjuvant chemotherapy (OR 5.07; 95%CI 1.41–18.19). Unlike loss of skeletal muscle density, loss of skeletal muscle mass showed no association with postoperative outcomes. Conclusion: In older patients with ovarian cancer, loss of skeletal muscle density during NACT is associated with worse postoperative outcomes. These results could add to perioperative risk assessment, guiding the decision to undergo surgery or the need for perioperative interventions

Low preoperative skeletal muscle density is predictive for negative postoperative outcomes in older women with ovarian cancer

Objective. To determine the predictive value of lumbar skeletal muscle mass and density for postoperative outcomes in older women with advanced stage ovarian cancer.Methods. A multicenter, retrospective cohort study was performed in women >= 70 years old receiving surgery for primary, advanced stage ovarian cancer. Skeletal muscle mass and density were assessed in axial CT slices on level L3. Low skeletal muscle mass was defined as skeletal muscle index = 2).Conclusion. Low skeletal muscle density, as a proxy of muscle quality, is associated with poor postoperative outcomes in older patients with advanced stage ovarian cancer. These findings can contribute to postoperative risk assessment and clinical decision making. (C) 2021 The Author(s). Published by Elsevier Inc.Cervix cance

Adenocarcinoma in Situ of the Uterine Cervix-A Systematic Review

Objective: This study aimed to review literature if therapeutic strategies in adenocarcinoma in situ of the cervix could lead to a more conservative approach. Methods: A review of the literature was conducted using a Medline search for articles published between 1966 and 2013. Results: Thirty-five studies showed that after a radical cone, 16.5% residual disease in the re-cone or uterus was found. After cone with positive margins, residual abnormalities were found in 49.3%. Thirty-seven studies showed 5% recurrence rate after conservative therapy (large loop excision transformation zone-cold knife conization. After conization with negative margins, the risk of recurrence was 3%. Conclusions: Adenocarcinoma in situ is a relatively rare premalignant but increasingly frequent lesion of the cervix. Although there is a risk of relapse (3%) with a chance of malignancy (<1%), this risk is so small that conservative treatment with negative margins by large loop excision transformation zone or cold knife conization is justified and justifiable not only for women to have children