Histopathological evaluation of lymphatic nodules in cancer of the uterine cervix Coordinators: First Author: Asist. Univ. Dr. Chira Liliana Stud. Bogdan Daniel Jerdea Prof. Univ. Dr. Stolnicu Simona Other Authors: Stud. Paul Ruzsa Stud. Ioan Sorin Pop Stud. Marinela-Radiana Faur Stud. Mihaela Bianca Ilie

On worldwide scale the cervical carcinoma is ranked the second after breast cancer in female cancer pathology Conducted studies show that radical trachelectomy with pelvic lymphadenectomy have the same results as radical hysterectomy (Alexander F. Burnett M.D.,Gynecologic Oncology 88,3: , march 2003). Another study reveals that adjuvant treatment with radiotherapy and chemotherapy significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix (William A. Peters III M.D., P.Y. Liu M.D., J Clin Oncol 18: by American Society of Clinical Oncology) Also one study shows that among patients without pelvic lymph node metastases but at high risk of recurrence, those who received adjuvant radiotherapy had significantly better reccurence free survival and marginally improved overall survival compared with those who received no adjuvant therapy (Chyong-Huey Lai M.D., Ji-Hong Hong M.D.,CANCER April 1, 1999 /85 / 7: ) Background

Regarding the more sensitive and actual problem of the adenocarcinomas of the uterine cervix some studies tried to classify them by their pattern of invasion in order to see which are the best candidates for lymphadenectomy and which not (Andrea Diaz De Vivar, M.D., Andres A. Roma, M.D.,International Journal of Gynecological Pathology 32:592–601, Lippincott Williams & Wilkins, Baltimore) One study concludes that the combination of surgery and radiotherapy has the worst morbidity, especially urological complications. The optimum therapy for each patient should take account of clinical factors such as menopausal status, age, medical illness, histological type, and cervical diameter to yield the best cure with minimum complications (Dr Fabio Landoni MD, Andreea Maneo MD,The Lancet, Volume 350,Issue 9077,23 August 1997, Pages 535–540) These being said the issue regarding cervical carcinomas and their lymphatic invasion is still the subject of many researches and a theme of actuality in the medical field

1 To observe and evaluate the histopathological aspect of the malign tissue To asses and observe the histopathological aspect of the lymphatic nodes regarding patients suffering from cervical carcinoma To asses the efficiency of the type of treatment chosen, given the above The Objectives of This Study 2 3 4

Materials and Methodes Our retrospective study was conducted on a sample of 160 cases We analyzed and compared the data of the histopathological reports from the years from the Laboratory of Pathology, SPCJU Tirgu Mures The main inclusion criteria was: patients suffering of cervical carcinoma who have undergone surgical treatment

Results From 160 cases, 124 suffered hysterectomy with lymphadenectomy(77%) of whom:  37.10% received preoperative treatment  27.41% had lymph nodes with metastasis Of the total of 53 cases which had been preoperative treated we discovered :  % of them showed residues of malign tissue Still,  from the 46 patients that have undergone treatment and had lymphadenectomy only 15.21% presented lymph nodes with metastasis

General assessment and repartition of the malign tissue according to the form of preoperative treatment that patients had

General evaluation of the state of the lymphatic nodes according to the form of preoperative therapy our patients had

Evaluation of the presence of malign tissue on the cervix given the clinical staging and form of therapy Overall presence of preoperative treatment given the clinical stage

Overall state of the lymph nodes given the clinical staging and form of preoperative therapy

Assessment of the microscopic types of carcinomas given the clinical staging and presence of preoperative treatment Squamous cell carcinoma, evaluation of the presence of malign tissue on the cervix Squamous cell carcinoma, evaluation of the state of lymph nodes

Adenocarcinomas State of the lymph nodes Presence of the tumoral tissue on the cervix

Other types of epithelial carcinomas, Adenosquamous carcinoma State of the lymph nodes Presence of the tumoral tissue on the cervix

Other types of epithelial carcinomas 1 case of basal adenoid carcinoma, stage 1, with no preoperative treatment and no metastasis in lymph nodes 1 case of cystic adenoid carcinoma, stage 2, with no preoperative treatment and less than 3 lymph nodes with metastasis 1 case of neuroendocrine carcinoma, stage 1, with no preoperative treatment and no metastasis in the lymph nodes

Effects on the malign tissue found in the pelvic lymph nodes Effects on the malign tissue found on the uterine cervix In early clinical stages of the squamous cell carcinoma, we observed absence of malign tissue in patients preoperative treated while in the late stages, the malign tissue persisted even if they were treated with RT and CT As for the adenocarcinomas and other epithelial tumors, malign tissue was found on the cervix in both preoperative treated patients and non-treated patients Preoperative treatment? At every clinical stage of the squamous cell carcinoma, lymph nodes with metastases were predominant in cases that didn’t received preoperative treatment As for the adenocarcinomas and other epithelial tumors, lymph nodes metastasis were identified in both preoperative treated patients and non-treated patients Stops or delays recurrences and spreading of the malign tissue Conclusions

Surgery Analysis and evaluation Preoperative treatment Efficiency Stop or delay recurrences Stop or delay the spreading of malign tissue Increase chances of survival while trying to maintain fertility Avoid post-operatory complications Guides Conclusions

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