Evangelos Paraskevaidis1, Antonios Athanasiou2, Ilkka Kalliala3, Anna Batistatou4, Maria Paraskevaidi5, Evripidis Bilirakis6, Maria Nasioutziki7, Minas Paschopoulos8, Deirdre Lyons9, Marc Arbyn10, Margaret Cruickshank11, Pierre Martin-Hirsch12, Maria Kyrgiou2. 1. Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece. Electronic address: eparaske@uoi.gr. 2. Institute or Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. 3. Institute or Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 4. Department of Pathology, University Hospital of Ioannina, Ioannina, Greece. 5. Institute or Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK. 6. Department of Obstetrics & Gynaecology, IASO Hospital, Athens, Greece. 7. Second Department of Obstetrics & Gynaecology, University Hospital of Thessaloniki, Thessaloniki, Greece. 8. Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece. 9. Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. 10. Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium. 11. Department of Obstetrics & Gynaecology, University of Aberdeen, Aberdeen, Scotland, United Kingdom. 12. Department of Obstetrics and Gynaecology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
Abstract
PURPOSE: 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. METHODS: Nine cervical cancer cases meeting the inclusion criteria, with available pathological and follow-up data, were considered eligible for this study. RESULTS: 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. CONCLUSION: 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.
PURPOSE: 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. METHODS: Nine cervical cancer cases meeting the inclusion criteria, with available pathological and follow-up data, were considered eligible for this study. RESULTS: 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. CONCLUSION: 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.