Management of adenocarcinoma in situ (ACIS) of the uteri cervix--a clinical dilemma.
OBJECTIVE
We retrospectively reviewed 24 cases of adenocarcinoma in-situ (ACIS) of the cervix, managed at KK Hospital, with the objective of determining our local approach to its treatment, the consequent clinical outcome and problems encountered.


METHODS
Except for one case, all patients were treated between 1991-1996. Nineteen cone biopsies (17 laser and 2 cold knife) and eleven hysterectomies were performed. The mean follow-up duration was 20.5 months (range: 1-75 months).


RESULTS
The mean age was 44.2 years (range: 32-68) with 80% of the cohort being more than 35 years old and the mean parity was 2.2. Six (25%) patients were symptomatic. Majority (21/23) had an abnormal initial Pap smear. Glandular lesions were found in 39% (9/23) of Pap smear, 28% (6/21) of colposcopy, 58% (8/14) of cervical biopsies and in 3 of 4 endocervical curettage. Of the 17 laser cone biopsy specimens, lesion involved the surgical margin in 6 patients (35%). ACIS was found in conjunction with CIN in 14 patients (58%). Five hysterectomies were performed for involved surgical margin and one for dubious surgical margin of the prior cone biopsy, of which 3 had residual ACIS. At the time of the study, there was no case of recurrent ACIS or overt adenocarcinoma developing following cone biopsy.


CONCLUSIONS
Preconisation diagnosis of ACIS using Pap smear, colposcopy and cervical biopsy was found to be difficult in our series. Concurrent CIN occurred in a sizeable portion of patients. Laser cone biopsy was the preferred method employed. Total hysterectomy was frequently employed following cone biopsy for treating possible residual disease. We recommend greater vigilance for this condition especially in patients with CIN and the need for regular endocervical sampling in the follow-up of patients treated by cone biopsy.
Tay
E H
EH
Department of Gynaecological Oncology & Urogynaecology, KK Women's and Children's Hospital, Singapore.
Yew
W S
WS
Ho
T H
TH
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D019092:Conization / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery