Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece.
Institute or Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2021 Sep;264:56-59. doi: 10.1016/j.ejogrb.2021.06.049. Epub 2021 Jul 3.
The aim of this study is to present a single department's experience on cervical cancer cases following previous excision of cervical intraepithelial neoplasia (CIN) and to discuss potential pathogenesis.
Nine cervical cancer cases meeting the inclusion criteria, with available pathological and follow-up data, were considered eligible for this study.
The majority (7/9) have had clear excisional margins. The interval between initial treatment and cancer diagnosis ranged from 7 to 17 years. In all cases cancer diagnosis was "unexpected", as the prior cytological and/or colposcopic evaluation was not suggestive of significant cervical pathology. All cancers were squamous, and 5/9 at stage I.
The long interval between initial CIN treatment and final diagnosis as well as the normal post-treatment follow-up may suggest a 'de novo' underlying but 'hidden' carcinogenesis process. It might be that dysplastic cells entrapped within crypts (or normal metaplastic affected by the same predisposing factors) continue undergoing their evolution, undetectable by cytology and colposcopy until they invade stroma and surfaces (endo- and/or ectocervical) approximately a decade later. Heavy cauterisation of cervical crater produced post excision might be a potential culprit of this entrapment.
本研究旨在介绍单一科室在治疗宫颈上皮内瘤变（CIN）后发生宫颈癌病例的经验，并探讨其潜在的发病机制。
符合纳入标准且有完整的病理和随访资料的 9 例宫颈癌病例被认为适合本研究。
大多数（7/9）患者的切除边缘清晰。从初始治疗到癌症诊断的间隔时间为 7 至 17 年。在所有病例中，癌症诊断均为“意外”，因为先前的细胞学和/或阴道镜评估并未提示有明显的宫颈病变。所有癌症均为鳞状细胞癌，5/9 为Ⅰ期。
从初始 CIN 治疗到最终诊断的间隔时间较长，且治疗后随访正常，这可能表明存在一种“从头开始”的潜在但“隐匿”的癌变过程。可能是陷窝内的异型细胞（或受相同诱发因素影响的正常化生细胞）持续发生演变，细胞学和阴道镜检查无法检测到，直到大约 10 年后侵犯基质和表面（内或外宫颈）。宫颈切除术后的重度烧灼可能是这种嵌塞的一个潜在原因。
