Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Str Gh Marinescu nr 38, 540139, Romania.
Department of Pathology, Regional Institute of Oncology, Str General Henri Mathias Berthelot nr 2-4, Iasi 700483, Romania.
Ann Diagn Pathol. 2020 Jun;46:151503. doi: 10.1016/j.anndiagpath.2020.151503. Epub 2020 Mar 13.
The commonest site of recurrence in endometrial cancer (EC) is the vagina, with a rate of 16%. The aim of this study was to determine if vaginal recurrences in EC patients could develop due to contamination of the vagina with glandular tumor cells dropping off on polypoid, large size EC or tumors involving the endocervix, through manipulation of the uterus during surgery.
This pilot prospective study included 10 consecutive patients with EC, surgically treated with hysterectomy and additional lymphadenectomy according to stage. In every case, 2 proximal vaginal smears were collected before and during the hysterectomy procedure. All smears underwent Papanicolaou staining and the presence of atypical glandular cells in the smears was correlated with clinico-pathological parameters.
Residual tumor was identified on the surgical specimen in the 10 cases; the tumor characteristics were large size (median 6 cm), polypoid type (80%), infiltrating the cervix (70%), and infiltrating more than half of the myometrium (60%). The smears obtained from the vagina showed that five cases (50%) presented tumor cells of glandular type in all smears (before and during the surgery), while in 3 cases (30%) the smears were negative for tumor cells preoperatively, but positive in the perioperative smears.
Our results suggest that the vagina is most often contaminated preoperatively due to bleeding; however, the vaginal wound may also be contaminated perioperatively. We propose a change in the surgical procedure, which is easy to perform and inexpensive compared to postsurgical vaginal radiotherapy.
子宫内膜癌（EC）最常见的复发部位是阴道，复发率为 16%。本研究旨在确定 EC 患者阴道复发是否是由于在手术过程中子宫操作时，脱落的息肉状、大体积 EC 或累及宫颈内口的肿瘤的腺性肿瘤细胞污染阴道所致。
这是一项连续的前瞻性研究，纳入了 10 例连续接受子宫切除术和根据分期进行淋巴结切除术的 EC 患者。在每种情况下，在子宫切除术前和手术过程中收集 2 份近端阴道涂片。所有涂片均行巴氏染色，并将涂片上是否存在非典型腺细胞与临床病理参数相关联。
10 例病例中均在手术标本上发现残留肿瘤；肿瘤特征为大体积（中位数 6 cm）、息肉样类型（80%）、累及宫颈（70%）和浸润超过一半的子宫肌层（60%）。阴道涂片显示，5 例（50%）所有涂片（术前和手术期间）均显示腺性肿瘤细胞，而 3 例（30%）术前涂片无肿瘤细胞，而围手术期涂片阳性。
我们的结果表明，阴道在术前因出血而经常受到污染；然而，阴道伤口也可能在术后受到污染。我们建议改变手术程序，与术后阴道放疗相比，该程序易于操作且费用低廉。
