title: Unexpected tumor progression after conization for carcinoma in situ of the uterine cervix.
abstract: OBJECTIVE
  To determine the safety and usefulness of conization with an electrosurgical loop (the loop electrosurgical excision procedure [LEEP]) in young women with carcinoma in situ (CIS) of the uterine cervix.
  
  
  METHODS
  A retrospective medical chart review of five patients with CIS initially treated with LEEP conization between 2002 and 2010 and who later experienced recurrence in the form of invasive or advanced disease was conducted.
  
  
  RESULTS
  The median patient age at initial LEEP conization was 41years (33-56years). The margin status in conization specimens was positive in three of the five patients. The median time to detection of tumor progression was 50months (17-58months). Magnetic resonance imaging was effective in detecting tumor recurrence in all cases. In four patients, hysterectomy was performed to treat the recurrence; these four patients are currently alive and disease-free. One patient with cervical lymph nodes and bone metastases was treated with chemotherapy alone; however, the patient died. In surgical specimens, tumor progression was observed extending toward the endometrium in all five patients and toward the vagina in two patients.
  
  
  CONCLUSIONS
  This study indicates that patients with CIS occasionally show unexpected tumor progression after conization and the progression could be life-threatening. Recurrent disease often shows tumor progression toward the endometrium or vagina, leading to difficulties in its detection at periodic pelvic examinations.
authors.affiliation: Departments of Gynecology Diagnostic Radiology Pathology, Cancer Institute Hospital, Tokyo, Japan. kohei.omatsu@jfcr.or.jp
authors.forename: Kohei
authors.initials: K
authors.lastname: Omatsu
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeshima
authors.forename: Maki
authors.initials: M
authors.lastname: Matoda
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nomura
authors.forename: Kenji
authors.initials: K
authors.lastname: Umayahara
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Kuniko
authors.initials: K
authors.lastname: Utsugi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tanaka
authors.forename: Futoshi
authors.initials: F
authors.lastname: Akiyama
authors.forename: Ken
authors.initials: K
authors.lastname: Takizawa
mesh_terms: D000328:Adult; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D019092:Conization; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery