Sopracordevole Francesco, Rossi Diego, Di Giuseppe Jacopo, Angelini Marta, Boschian-Bailo Pierino, Buttignol Monica, Ciavattini Andrea
Department of Gynecologic Oncology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
Department of Pathology, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Pordenone, Italy.
Case Rep Obstet Gynecol. 2014;2014:296253. doi: 10.1155/2014/296253. Epub 2014 Mar 16.
Microinvasive adenocarcinoma (MIAC) of the uterine cervix is rare in pregnancy. Published data on conservative treatment of MIAC both in pregnant and nonpregnant women are scarce. A conservatively treated case of MIAC in a 13-week-pregnant woman after a diagnosis of atypical glandular cells (AGC) on pap smear at the 6th week of pregnancy is presented. The problems of suspected adenocarcinoma in situ (AIS) on biopsy and MIAC on cone biopsy in pregnancy, as well as the risks and benefits of a conservative treatment are discussed. After colposcopic guide laser cervical conization and expression of informed consent the patient underwent followup and vaginal delivery at 40 weeks plus 3 days of gestation. In this case, no obstetric complication has been recorded after the cervical conization, and after a followup of 18 months the patient was alive and free of disease, with negative results as far as pap smear, colposcopy, HPV status, and cervical curettage are concerned. In a stage Ia1 disease of endocervical type, with clear margins and without lymph-vascular space invasion, cervical conization performed during the second trimester may be considered a definitive and safe treatment, at least up to delivery, after expression of informed consent by the woman.
子宫颈微浸润腺癌（MIAC）在妊娠期间较为罕见。关于妊娠和非妊娠女性MIAC保守治疗的已发表数据很少。本文介绍了一例在妊娠第6周巴氏涂片诊断为非典型腺细胞（AGC）后，于妊娠13周时接受保守治疗的MIAC病例。讨论了妊娠活检时疑似原位腺癌（AIS）和锥形活检时MIAC的问题，以及保守治疗的风险和益处。在阴道镜引导下进行激光宫颈锥形切除术并获得知情同意后，患者接受随访并在妊娠40周加3天时经阴道分娩。在该病例中，宫颈锥形切除术后未记录到产科并发症，随访18个月后患者存活且无疾病，巴氏涂片、阴道镜检查、HPV状态和宫颈刮除术结果均为阴性。对于宫颈管型Ia1期疾病，切缘清晰且无淋巴血管间隙浸润，在妊娠中期进行宫颈锥形切除术，在女性获得知情同意后，至少至分娩前可被视为一种明确且安全的治疗方法。
