Histopathological evaluation of lymphatic nodules in cancer of the uterine cervix

Coordinators: First Author: Asist. Univ. Dr. Chira Liliana Stud. Bogdan Daniel Jerdea

Prof. Univ. Dr. Stolnicu Simona Other Authors: Stud. Paul Ruzsa Stud. Ioan Sorin Pop Stud. Marinela-Radiana Faur Stud. Mihaela Bianca Ilie

• On worldwide scale the cervical carcinoma is ranked the second after breast cancer in female cancer pathology

• Conducted studies show that radical trachelectomy with pelvic lymphadenectomy have the same results as radical hysterectomy (Alexander F. Burnett M.D.,Gynecologic Oncology 88,3: 419-423, march 2003).

• Another study reveals that adjuvant treatment with radiotherapy and chemotherapy significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix (William A. Peters III M.D., P.Y. Liu M.D., J Clin Oncol 18:1606-1613. 2000 by American Society of Clinical Oncology)

• Also one study shows that among patients without pelvic lymph node metastases but at high risk of recurrence, those who received adjuvant radiotherapy had significantly better reccurence free survival and marginally improved overall survival compared with those who received no adjuvant therapy (Chyong-Huey Lai M.D. , Ji-Hong Hong M.D.,CANCER April 1, 1999 /85 / 7: 1537-1545)

Background

• Regarding the more sensitive and actual problem of the adenocarcinomas of the uterine cervix some studies tried to classify them by their pattern of invasion in order to see which are the best candidates for lymphadenectomy and which not (Andrea Diaz De Vivar, M.D., Andres A. Roma, M.D.,International Journal of Gynecological Pathology 32:592–601, Lippincott Williams & Wilkins, Baltimore)

• One study concludes that the combination of surgery and radiotherapy has the worst morbidity, especially urological complications. The optimum therapy for each patient should take account of clinical factors such as menopausal status, age, medical illness, histological type, and cervical diameter to yield the best cure with minimum complications (Dr Fabio Landoni MD , Andreea Maneo MD,The Lancet, Volume 350,Issue 9077,23 August 1997, Pages 535–540)

• These being said the issue regarding cervical carcinomas and their lymphatic invasion is still the subject of many researches and a theme of actuality in the medical field

1To observe and evaluate the histopathological aspect of the malign tissueTo asses and observe the histopathological aspect of the lymphatic nodes regarding patients suffering from cervical carcinoma

To asses the efficiency of the type of treatment chosen, given the above

The Objectives of This Study

2

3

4

Materials and Methodes

• Our retrospective study was conducted on a sample of 160 cases

• We analyzed and compared the data of the histopathological reports from the years 2012-2013 from the Laboratory of Pathology , SPCJU Tirgu Mures

• The main inclusion criteria was: patients suffering of cervical carcinoma who have undergone surgical treatment

Results

From 160 cases, 124 suffered hysterectomy with lymphadenectomy(77%) of whom: 37.10% received preoperative treatment 27.41% had lymph nodes with metastasisOf the total of 53 cases which had been preoperative treated we discovered : 60. 37% of them showed residues of malign tissue Still, from the 46 patients that have undergone treatment

and had lymphadenectomy only 15.21% presented lymph nodes with metastasis

130

10

11

15

11 1

Repartition of the carcinomas by microscopical type in our patients

squamous cell carcinoma

mucinous adenocarcinoma

serous adenocarcinoma

mezonefric adenocarcinoma

other types of epithelial carcinomas, adenosquamous

other types of epithelial carcinomas, cystic adenoid

other types of epithelial carcinomas, basal adenoid

other types of epithelial carcinomas, neuroendocrine ade-nocarcinoma

I II III IV N

Squamous Carcinoma 44 45 4 6 31

Adenocarcinoma 7 4 0 1 0

Adenosquamous Carcinoma 8 7 0 0 0

Other types of epithelial carcinomas 2 1 0 0 0

2.5

7.5

12.5

17.5

22.5

27.5

32.5

37.5

42.5

Repartition of the microscopic types of carcinomas according to their clinical

staging

General assessment and repartition of the malign tissue according to the form of preoperative treatment that patients had

tumoral

tissue a

fter co

mplete p

reopera

tive tr

eatm

ent

tumoral tissu

e in pati

ents

that had

no preopera

tive tr

eatm

ent

tumoral

tissue

in patien

ts that

had only

chem

otherapy

tumoral tissu

e in pati

ents

that had

only rad

iotherapy

0

10

20

30

40

50

60

70

80

90

100

110

120

21

107

29

12

0

0 9

Present (Residual) Absent

General evaluation of the state of the lymphatic nodes according to the form of preoperative therapy our patients had

0

10

20

30

40

50

60

70

80

90

100

311

1 12

16

00

25

51

1

13

Present in less than 3 Iymph nodes Present in more than 3 lymph nodesAbsent from lymph nodes

56%

10%

11%

19%3%

General assessment of the state of the lymph nodes and

surgical procedures con-ducted lymph nodes without

metastasisless than 3 lymph nodes with metas-tasismore than 3 lymph nodes with metas-tasishysterectomy without lym-phadenectomyconization

Evaluation of the presence of malign tissue on the cervix given the clinical staging and form of therapy

Overall presence of preoperative treatment given the clinical stage

I

II

III

IV

Unspecified clinical stage

0% 20% 40% 60% 80% 100%

11

32

1

3

6

50

25

3

4

25

With preoperative treatment without preoperative treatement

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

I II III IV N

0

10

20

30

40

50

60

47

3

25

0 3 0 4 0

25

0

5

6

19

13 1

0

3

0

4

2

Without preoperative treatment With preoperative treatment

Overall state of the lymph nodes given the clinical staging and form of preoperative therapy

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

I II III IV N

05

101520253035404550

8

37

11 93 0 2 0 3 5

1

9

4

26

00

11

1 3

Preoperative treatment is absent Preoperative treatment is present

Assessment of the microscopic types of carcinomas given the clinical staging and presence of preoperative treatmentSquamous cell carcinoma,

evaluation of the presence of malign tissue on the cervix

Squamous cell carcinoma, evaluation of the state of lymph nodes

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

I II III IV N

0

5

10

15

20

25

30

35

0

94

21

0 0 1 1 1 37

23

8

7

30

2 0 35

Squamous cell carcinoma, Preoperative treatment is presentSquamous cell carcinoma, Preoperative treatment is absent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

I II III IV N

0

5

10

15

20

25

30

35

4 6

1512

1 03

04 2

31

3

18

0

3

0

3

0

25

0

Squamous cell carcinoma, With preoperative treatmentSquamous cell carcinoma, Without preoperative treatment

Adenocarcinomas State of the lymph nodes

Presence of the tumoral tissue on the cervix

Lymph nodes with metastasis

Lymph nodes without metastasis

Lymph nodes with metastasis

Lymph nodes without metastasis

I II

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1

0 0

3

0

5

1

0

Adenocarcinoma, Preoperative treatment is presentAdenocarcinoma, Preoperative treatment is absent

of wich 1 case of mezonefric adenocarcinoma , stage II that had complete preoperative treatment and has no metastasis in the lymph nodes1 case of serous adenocarcinoma , stage II that had no preoperative treatment and has more than 3 lymph nodes with metastasis1 case of mucinous adenocarcinoma without lymphadenectomy performed, stage I1 case of mucinous adenocarcinoma without lymphadenectomy, stageIV

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

I II III IV

01234567

10

3

0 0 0 0 0

6

0

1

0 0 01

0

Adenocarcinoma, With preoperative treatmentAdenocarcinoma, Without preoperative treatment

Other types of epithelial carcinomas, Adenosquamous carcinoma State of the lymph nodes

Presence of the tumoral tissue on the cervix

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

Lym

ph n

odes

with

met

asta

sis

Lym

ph n

odes

with

out m

etas

tasis

I II

0

1

2

3

4

5

6

7

0 0 0

21

7

1

2

Adenosquamous carcinoma, Preoperative treatment is presentAdenosquamous carcinoma, Preoperative treatment is absent

2 cases of adenosquamous carcinoma ,stage 2 without lymphadenectomy

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

Tum

oral

tiss

ue is

pre

sent

Tum

oral

tiss

ue is

abs

ent

I II

0

1

2

3

4

5

6

7

8

0 01 1

8

0

5

0

Adenosquamous carcinoma, With preoperative treatmentAdenosquamous carcinoma, Without preoperative treatment

Other types of epithelial carcinomas

• 1 case of basal adenoid carcinoma, stage 1, with no preoperative treatment and no metastasis in lymph nodes

• 1 case of cystic adenoid carcinoma, stage 2, with no preoperative treatment and less than 3 lymph nodes with metastasis

• 1 case of neuroendocrine carcinoma, stage 1, with no preoperative treatment and no metastasis in the lymph nodes

Effects on the malign tissue found in the pelvic lymph nodes

Effects on the malign tissue found on the uterine cervix

• In early clinical stages of the squamous cell carcinoma, we observed absence of malign tissue in patientspreoperative treated while in the late stages, the malign tissue persisted evenif they were treated with RT and CT • As for the adenocarcinomas and other epithelial tumors,malign tissue was found on the cervix in both preoperativetreated patients and non-treated patients

Preoperative treatment?

• At every clinical stage of the squamous cell carcinoma, lymph nodes with metastases were predominant in cases that didn’t received preoperative treatment

• As for the adenocarcinomas and other epithelial tumors, lymph nodes metastasis were identified in both preoperative treated patients and non-treated patients

Stops or delays recurrences

and spreading of the malign

tissue

Conclusions

SurgeryAnalysis and

evaluation

Preoperative

treatment

Efficiency • Stop or delay

recurrences• Stop or delay the spreading of malign

tissue• Increase chances of survival while trying to

maintain fertility• Avoid post-operatory

complications

Guides

Conclusions

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