Cervical Adenocarcinoma in Situ: Update and Management
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MANAGEMENT OF HPV AND ASSOCIATED CERVICAL LESIONS (B BARRETTE, SECTION EDITOR)
Cervical Adenocarcinoma in Situ: Update and Management Stephan Polterauer & Alexander Reinthaller & Reinhard Horvat & Elmar Joura & Christoph Grimm
Published online: 2 March 2013 # Springer Science+Business Media New York 2013
Abstract Adenocarcinoma in situ (AIS) of the uterine cervix is caused by infection with high-risk human papillomavirus and is the recognized precursor of invasive adenocarcinoma of the cervix. Because most AIS lesions are caused by HPV 16/18 infection, prophylactic HPV vaccination is an important step toward prevention of AIS, potentially reducing the incidence of invasive adenocarcinoma. Nonetheless, at the moment the incidence of AIS and invasive adenocarcinoma continues to increase, especially among young women when fertility preservation is an issue. Both diagnosis and treatment of AIS is challenging, because AIS lesions frequently extend into the endocervical canal, making detection and complete excision difficult. Hysterectomy remains the standard treatment for AIS. S. Polterauer (*) : A. Reinthaller : E. Joura : C. Grimm Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Gynecologic Cancer Unit, Medical University Vienna, Austria, Waehringer Guertel 18-20, A-1090 Vienna, Austria e-mail: [email protected] URL: www.ccc.ac.at/gcu/ A. Reinthaller e-mail: [email protected] E. Joura e-mail: [email protected] C. Grimm e-mail: [email protected] A. Reinthaller Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria R. Horvat Department of Pathology, Division Gynecologic Pathology, Medical University of Vienna, Vienna, Austria e-mail: [email protected]
Selected patients, who wish to preserve fertility, with clear margins and negative ECC after initial conization are potential candidates for conservative treatment. If margins are involved after initial conization or ECC results are positive, the risk of residual or recurrent AIS and invasive adenocarcinoma of the cervix is considerably high. In these women, repeat surgery should be performed. For women, who do not undergo hysterectomy, long-term follow-up is recommended. Keywords ACIS . AIS . Atypical glandular cells . Cervical adenocarcinoma in situ . Endocervical canal . Management of HPV . Human papillomavirus . HPV
Introduction Cervical adenocarcinoma in situ (AIS) arises in the glandular epithelium of the uterine cervix and is the recognized precursor to invasive adenocarcinoma [1•]. The incidence rate of AIS is much lower compared with cervical intraepithelial neoplasia (CIN) [2]. In contrast to CIN and squamous cervical cancer (SCC), which declined during the past decades, the incidence of AIS and invasive adenocarcinoma continues to increase, especially among young women [2]. Multicentricity with foci high in the endocervical canal and skip lesions a
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