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Adenoid cystic carcinoma of the cervix in women under age 40
GYNECOLOGIC
ONCOLOGY
32, 26-30 (1989)
Adenoid Cystic Carcinoma of the Cervix in Women under Age 40 LAUREL
A. KING, M.D., 0. EDUARDO TALLEDO, M.D., DONALD G. GALLUP, M.D., OLA MELHUS, M.D., AND LUTHER B. OTKEN, M.D.
Departments of Obstetrics and Gynecology and Pathology, Medical College of Georgia, Augusta, Georgia 30912 Received July 1, 1987
College of Georgia from January 1, 1980, to December
Adenoid cystic carcinoma of the cervix, traditionally associated with a poor prognosis, occurs in postmenopausal patients in the 31, 1986, were reviewed. During the period of study, 289 vast majority of casesreported. Only four caseshave been reported patients were treated for primary invasive cervical cancer. in women less than age 40, and none in women less than age All patients in this study were presented to an informal tumor con30. Three new cases of adenoid cystic carcinoma of the cervix or formal gynecologic-radiation-pathology are reported in women aged 24, 27, and 38 years. All three ference for final evaluation and staging. These three cases patients were treated with radical pelvic surgery; lymph node of adenoid cystic carcinoma constituted 1.03% of all metastasesand vascular involvement were prominent. Adjuvant cervical cancers managed during the stated time. chemotherapy with cisplatin was used in two patients, one of whom has had long-term survival. A review of the literature is Case I also presented. 0 1989 Academic Pres, Inc.
A 27-year-old white female, gravida 3, para l-0-2-1, referred to the Medical College of Georgia (MCG) for Adenoid cystic carcinoma of the cervix, also known as cylindroma, cylindromatous adenocarcinoma, adeno- evaluation of a class IV cervical cytology done 5/27/86. Her previous smear was 6/4/U, and she had had annual myoepithelioma, or adenocystic carcinoma, was first recervical smears at her local health department. She had ported in 1949 by Paalman and Counseller [I]. These been on birth control pills since her last pregnancy in lesions are believed to arise from subcolumnar reserve cells of the endocervical mucous membrane. Only 120 1979. No gross cervical lesions were present. However, cases have been reported in the literature. The vast ma- colposcopy revealed aceto-white epithelium. She was jority of cases have occurred in postmenopausal women, staged as FIG0 IB. Radical hysterectomy and pelvic and most cases are seen between the sixth and seventh lymphadenectomy was performed 7/28/86. Pathologic examination revealed adenoid cystic carcinoma of cervix decades. Only four cases have been reported in women invasive to the inner one-third of the cervical stroma, less than 40 years of age [2,3,4]. No cases have been vascular and lymphatic invasion, and squamous carcinoma reported in women less than age 30. In general, adenoid in situ of glands (Figs. 1 and 2). Lymph nodes were cystic cervical carcinoma is felt to have a worse prognosis, negative for metastases. She received six courses of adstage-for-stage, when compared to epidermoid carcinoma juvant cisplatin chemotherapy, 100 mg/m’, and is without of the cervix [5,6]. Few reports of long-term survival recurrence 12 months postsurgery. after adjunctive chemotherapy exist. The three new cases in this report represent the fifth, Case II sixth, and seventh cases in women under age 40 and the A 38-year-old black female, gravida 4, para 3-O-l-3, first two reported cases in women under 30 years of age. presented to her local emergency room after a syncopal One of these three new cases had positive nodes and episode. She reported severe menorrhagia for several parametrial and vaginal spread. She has had long-term months; hemoglobin was 2.2 gm/dl. She was transferred survival after adjuvant chemotherapy with cisplatin. to MCG after stabilization. Examination revealed an enlarged, firm cervix replaced by a 5-cm fungating mass. MATERIALS AND METHODS Her last pregnancy was 1959, and she had not had a The clinical records of all patients with a diagnosis of cervical smear in many years. Metastatic workup including carcinoma of the uterine cervix managed at the Medical chest X ray, intravenous pyelogram (IVP), barium enema, 26 0090~8258/89$1.50 Copyright 0 1989 by Academic Press, Inc. All rights of reproduction in any form reserved.
ADENOID CYSTIC CARCINOMA
27
OF CERVIX
sonogram. A chest X ray was suspicious or a mass in the right hilar area. She expired 12/82 secondary to uremia. Case III
A 24-year-old white female, gravida 1, para l-O-0-1, referred to MCG for a class V cervical smear 1l/81 and cervical biopsies suspicious for adenocarcinoma of the cervix. Her last pregnancy was 1973 and she had been on oral contraceptives since then. No gross cervical lesions were present. Colposcopic examination revealed acetowhite epithelium and mosaic pattern. Conization of the cervix was performed l/82 and showed adenoid cystic carcinoma involving all margins of the cone. Metastatic workup was unremarkable and she was staged as FIG0 IB. Radical hysterectomy and pelvic lymphadenectomy was performed 2/23/82. Pathologic examination revealed adenoid cystic carcinoma with deep stromal invasion, extensive vascular permeation, and extension to both right and left parametriae and the anterior vagina. The vagina surgical margin was clear. Metastatic carcinoma was present in a left obturator lymph node (Fig. 3). She received six courses of cisplatin adjuvant chemotherapy, 100 mg/m’. She is without evidence of recurrent disease 64 months later. DISCUSSION Of the seven cases of adenoid cystic carcinoma of the cervix in women under age 40, including the three reported from our own institution, all but one had stage IB disease (Table 1). Vaginal bleeding was the presenting symptom in four of seven; but the remaining three had no symptoms, FIG. 1. Adenoid cystic carcinoma with characteristic cribiform pattern undermining normal-appearing squamous mucosa (H&E x 20). and abnormal cervical cytologic smears led to the eventual diagnosis. When cases occurring in women of all ages liver-spleen scan, and cystoscopy was negative and she are considered, abnormal vaginal bleeding was the prewas staged FIG0 IB. Radical hysterectomy and pelvic senting complaint in 6%, and abnormal cervical cytologies lymphadenectomy was performed on 11/24/8 1. Pathologic alone was noted in 22% [2,5-l 11. examination revealed adenoid cystic carcinoma of the Two of the three patients in this report (Patients 1 and endocervix and extensive vascular invasion; metastatic 3), had been on combination oral contraceptives for longer carcinoma was present in the right and left hypogastric than 3 years. nodes. She was lost to follow-up from 12/81 until 6/16/82 Six of the seven patients with this neoplasm were treated when she presented to the MCG emergency room with by radical surgery, and four of six (66%) had positive acute urinary retention, pyelonephritis , and gram-negative nodes (Table 1). A review of stage I adenoid cystic cervical sepsis. IVP was negative for ureteral obstruction, but cancers indicates that 70% of patients have positive nodes cystoscopy was positive for metastatic carcinoma in the [2,5,6,12-151 (Table 2). This high rate of node positivity bladder and urethra. A femoral node biopsy was also must be considered in patients with adenoid cystic cervical positive for carcinoma. A suprapubic catheter was placed carcinoma. for long-term urinary drainage. By 10/82, she was noted Adenoid cystic carcinoma, usually seen in salivary to have circumferential tumor involvement of the vagina. glands and the respiratory tract, has also been reported She was admitted 1l/17/82 for dyspnea and severe anemia in skin, breast, and Bartholin’s gland. Extensive lymphatic and had bilateral ureteral obstruction. She was noted to and vascular involvement is common; perineural invasion have extensive paraaortic adenopathy on abdominal is also seen [8]. Vascular involvement was seen in all
FIG. 2. Vascular spaces, probably lymphatics, containing tumor, adjacent to medium-sized arteries (H&E x 100).
FIG. 3. Metastatic gland-forming carcinoma in peripheral sinuses of left obturator lymph node (H&E x40). 28
ADENOID CYSTIC CARCINOMA
29
OF CERVIX
TABLE 1 Adenoid Cystic Carcinoma of the Cervix in Women under Age 40 FIG0 stage
Therapy
Node Status
Outcome
Age
Race
Pt. No. 1 (MU3
24
W
GlPl
IB
RH, PLND 6 courses Chemotherapy
-
NED 12 months
Pt. No. 2 W3-3
38
b
G4P3Al
IB
RH, PLND
+
DOD 13 months
Pt. No. 3 (MCG)
27
W
G3PlA2
IB
RH, PLND 6 courses chemotherapy
+
NED 64 months
Pt. No. 4 (Hoskins et al.) [2]
31
W
GOP0
IB
RH, PLND pelvic XRT
+
NED 28 months
Pt. No. 5 (Hoskins et al.) [2]
33
W
G3P3
IB
RH, PLND pelvic XRT Cranial XRT
+
Brain and bone metastases DOD 29 months
Pt. No. 6 (Bag&h and Woodruff) [3]
39
B
GlPl
IB
TVH
Pt. No. 7 (Kovi) [4]
31
B
G7P6A 1
IIA
RH, PLND
Unknown
-
NED
Unknown
Note. RH, PLND, radical hysterectomy, pelvic lymphadenectomy; XRT, external radiation; TVH, total vaginal hysterectomy; MCG, Medical College of Georgia; DOD, dead of disease; NED, no evidence of disease.
three of our patients and has been reported by others [5,12,16]. The optimal primary treatment for early stage lesions is unknown. On the basis of a relatively high incidence of positive lymph nodes, vascular involvement, and distant metastatic disease, Fowler and associates recommended adjuvant chemotherapy IS]. They noted no response in two patients treated with bleomycin, 5-fluorouracil, and doxorubicin. Similarly, Hoskins et al. found little benefit from doxorubicin and cyclophosphamide [2]. Phillips and Frye, however, reported a complete response in one TABLE 2 Lymph Node Metastases in Stage 1 Adenoid Cystic Carcinoma of the Cervix Series Dinh and Woodruff [6] Hoskins et a/. [2] Audet LaPointe er al. [14] Fowler et al. [5] Miles and Norris [12] McGee et al. [15] Phillips and Frye [13] Medical College of Georgia Total
Patients with positive nodes 0 3 0 2 9 0 0 2 16
Total patients 1 4 1 2 10 1 1 3 23 = 70%
patient treated for recurrent adenoid cystic cervical carcinoma with nine courses of cisplatin, doxorubicin, and cyclophosphamide [ 131.The absence of disease at 12 and 64 months in two of our patients treated with relatively high dose cisplatin in an adjuvant setting suggests that this drug may have activity in patients with adenoid cystic tumors. Standard treatment for patients of all ages with adenoid cystic cervical cancer results in relatively poor survival. Prempree, in a recent review of 43 cases, noted a 56.2% 3- to 5-year survival for stage I disease, regardless of treatment modality [9]. Survival rate for all stages was 32.5% [9].
In summary, adenoid cystic carcinoma of the cervix is a rare neoplasm usually occurring in postmenopausal women. Vaginal bleeding and abnormal cervical cytology are the most common presenting complaints. Lymph node metastases are seen in a majority of patients with early stage disease, and vascular involvement is common. Chemotherapy regimens that utilize cisplatin may be a useful adjunct in the treatment of patients with adenoid cystic carcinoma of the cervix. REFERENCES 1. Paalman, R. J., and Counseller, V. S. Cylindroma of the cervix with procidentia, Amer. J. Obstet. Gynecol. 58, 184-187 (1949).
30
KING ET AL.
2. Hoskins, W. J., Averette, H. E., Ng, A. B. P., et al. Adenoid cystic carcinoma of the cervix uteri: Report of six cases and review of the literature, Gynecol. Uncol. 7, 371-384 (1979). 3. Baggish, M. S., and Woodruff, J. D. Adenoid-basal carcinoma of the cervix, Obstet. Gynecol. 28, 213-218 (1966). 4. Kovi, J. Adenoid cystic carcinoma of the cervix with myxochondroid change: Report of a case. Med. Ann. D. C. 41, 633-634 (1972). 5. Fowler, W. C., Jr., Miles, P. A., Surwit, E. A., Edelman, D. A., Walton, L. A., and Photopulos, G. J. Adenoid cystic carcinoma of the cervix. Report of 9 cases and a reappraisal, Obstet. Gynecol. 52, 337-342 (1978). 6. Dinh, T. V., and Woodruff, J. D. Adenoid cystic and adenoid basal carcinomas of the cervix, Obstet. Gynecol. 65, 705-709 (1985). Musa, A. G., Hughes, R. R., and Coleman, S. A. Adenoid cystic carcinoma of the cervix: A report of 17 cases, Gynecol. Oncol. 22, 167-173 (1985). Berchuck, A., and Mullin, T. J. Cervical adenoid cystic carcinoma associated with ascites, Gynecol. Oncol. 22, 201-211 (1985). Prempree, T., Villasanta, U., and Tang, C. K. Management of adenoid cystic carcinoma of the uterine cervix (cylindroma): Report of six cases and reappraisal of all cases reported in the medical literature, Cancer 46, 1631-1635 (1980).
10. Gonzalez, S. Adenoid cystic pattern in uterine cervical carcinoma: Report of three cases, J. Miss. State Med. Assoc. 25(8), 207-209 (1984). 11. Nel, C. P., and Tiltman, A. J. Adenoid cystic carcinoma of the uterine cervix: A report of two cases, S. Afr. Med. J. 53(26), 10731075 (1978). 12 Miles, P. A., and Norris, H. J. Adenoid cystic carcinoma of the ’ cervix: An analysis of 12 cases, Obsret. Gynecol. 38, 103-110 (1971). 13
Phillips, G. L., Jr., and Frye, L. P. Adenoid cystic carcinoma of the cervix: A case report with implications for chemotherapeutic treatment, Gynecol. Oncol. 22, 260-262 (1985).
14. Audet La Pointe, P., Vauclair, R., and Goeusse, P. A propos d’un cas de cylindrome du co1 uterin, J. Gynecol. Obstet. Biol. Reprod. 10, 203 (1981). 15. McGee, J. A., Flowers, C. E., and Tatum, B. S. Adenoid cystic carcinoma of the cervix: Report of a case, Obstet. Gynecol. 26, 356-358 (1965). 16. Mazur, M. T., and Battifora, H. A. Adenoid cystic carcinoma of the uterine cervix: Ultrastructure, immunofluorescence, and criteria for diagnosis, Amer. J. C/in. Pathol. 77, 494-500 (1982).
ONCOLOGY
32, 26-30 (1989)
Adenoid Cystic Carcinoma of the Cervix in Women under Age 40 LAUREL
A. KING, M.D., 0. EDUARDO TALLEDO, M.D., DONALD G. GALLUP, M.D., OLA MELHUS, M.D., AND LUTHER B. OTKEN, M.D.
Departments of Obstetrics and Gynecology and Pathology, Medical College of Georgia, Augusta, Georgia 30912 Received July 1, 1987
College of Georgia from January 1, 1980, to December
Adenoid cystic carcinoma of the cervix, traditionally associated with a poor prognosis, occurs in postmenopausal patients in the 31, 1986, were reviewed. During the period of study, 289 vast majority of casesreported. Only four caseshave been reported patients were treated for primary invasive cervical cancer. in women less than age 40, and none in women less than age All patients in this study were presented to an informal tumor con30. Three new cases of adenoid cystic carcinoma of the cervix or formal gynecologic-radiation-pathology are reported in women aged 24, 27, and 38 years. All three ference for final evaluation and staging. These three cases patients were treated with radical pelvic surgery; lymph node of adenoid cystic carcinoma constituted 1.03% of all metastasesand vascular involvement were prominent. Adjuvant cervical cancers managed during the stated time. chemotherapy with cisplatin was used in two patients, one of whom has had long-term survival. A review of the literature is Case I also presented. 0 1989 Academic Pres, Inc.
A 27-year-old white female, gravida 3, para l-0-2-1, referred to the Medical College of Georgia (MCG) for Adenoid cystic carcinoma of the cervix, also known as cylindroma, cylindromatous adenocarcinoma, adeno- evaluation of a class IV cervical cytology done 5/27/86. Her previous smear was 6/4/U, and she had had annual myoepithelioma, or adenocystic carcinoma, was first recervical smears at her local health department. She had ported in 1949 by Paalman and Counseller [I]. These been on birth control pills since her last pregnancy in lesions are believed to arise from subcolumnar reserve cells of the endocervical mucous membrane. Only 120 1979. No gross cervical lesions were present. However, cases have been reported in the literature. The vast ma- colposcopy revealed aceto-white epithelium. She was jority of cases have occurred in postmenopausal women, staged as FIG0 IB. Radical hysterectomy and pelvic and most cases are seen between the sixth and seventh lymphadenectomy was performed 7/28/86. Pathologic examination revealed adenoid cystic carcinoma of cervix decades. Only four cases have been reported in women invasive to the inner one-third of the cervical stroma, less than 40 years of age [2,3,4]. No cases have been vascular and lymphatic invasion, and squamous carcinoma reported in women less than age 30. In general, adenoid in situ of glands (Figs. 1 and 2). Lymph nodes were cystic cervical carcinoma is felt to have a worse prognosis, negative for metastases. She received six courses of adstage-for-stage, when compared to epidermoid carcinoma juvant cisplatin chemotherapy, 100 mg/m’, and is without of the cervix [5,6]. Few reports of long-term survival recurrence 12 months postsurgery. after adjunctive chemotherapy exist. The three new cases in this report represent the fifth, Case II sixth, and seventh cases in women under age 40 and the A 38-year-old black female, gravida 4, para 3-O-l-3, first two reported cases in women under 30 years of age. presented to her local emergency room after a syncopal One of these three new cases had positive nodes and episode. She reported severe menorrhagia for several parametrial and vaginal spread. She has had long-term months; hemoglobin was 2.2 gm/dl. She was transferred survival after adjuvant chemotherapy with cisplatin. to MCG after stabilization. Examination revealed an enlarged, firm cervix replaced by a 5-cm fungating mass. MATERIALS AND METHODS Her last pregnancy was 1959, and she had not had a The clinical records of all patients with a diagnosis of cervical smear in many years. Metastatic workup including carcinoma of the uterine cervix managed at the Medical chest X ray, intravenous pyelogram (IVP), barium enema, 26 0090~8258/89$1.50 Copyright 0 1989 by Academic Press, Inc. All rights of reproduction in any form reserved.
ADENOID CYSTIC CARCINOMA
27
OF CERVIX
sonogram. A chest X ray was suspicious or a mass in the right hilar area. She expired 12/82 secondary to uremia. Case III
A 24-year-old white female, gravida 1, para l-O-0-1, referred to MCG for a class V cervical smear 1l/81 and cervical biopsies suspicious for adenocarcinoma of the cervix. Her last pregnancy was 1973 and she had been on oral contraceptives since then. No gross cervical lesions were present. Colposcopic examination revealed acetowhite epithelium and mosaic pattern. Conization of the cervix was performed l/82 and showed adenoid cystic carcinoma involving all margins of the cone. Metastatic workup was unremarkable and she was staged as FIG0 IB. Radical hysterectomy and pelvic lymphadenectomy was performed 2/23/82. Pathologic examination revealed adenoid cystic carcinoma with deep stromal invasion, extensive vascular permeation, and extension to both right and left parametriae and the anterior vagina. The vagina surgical margin was clear. Metastatic carcinoma was present in a left obturator lymph node (Fig. 3). She received six courses of cisplatin adjuvant chemotherapy, 100 mg/m’. She is without evidence of recurrent disease 64 months later. DISCUSSION Of the seven cases of adenoid cystic carcinoma of the cervix in women under age 40, including the three reported from our own institution, all but one had stage IB disease (Table 1). Vaginal bleeding was the presenting symptom in four of seven; but the remaining three had no symptoms, FIG. 1. Adenoid cystic carcinoma with characteristic cribiform pattern undermining normal-appearing squamous mucosa (H&E x 20). and abnormal cervical cytologic smears led to the eventual diagnosis. When cases occurring in women of all ages liver-spleen scan, and cystoscopy was negative and she are considered, abnormal vaginal bleeding was the prewas staged FIG0 IB. Radical hysterectomy and pelvic senting complaint in 6%, and abnormal cervical cytologies lymphadenectomy was performed on 11/24/8 1. Pathologic alone was noted in 22% [2,5-l 11. examination revealed adenoid cystic carcinoma of the Two of the three patients in this report (Patients 1 and endocervix and extensive vascular invasion; metastatic 3), had been on combination oral contraceptives for longer carcinoma was present in the right and left hypogastric than 3 years. nodes. She was lost to follow-up from 12/81 until 6/16/82 Six of the seven patients with this neoplasm were treated when she presented to the MCG emergency room with by radical surgery, and four of six (66%) had positive acute urinary retention, pyelonephritis , and gram-negative nodes (Table 1). A review of stage I adenoid cystic cervical sepsis. IVP was negative for ureteral obstruction, but cancers indicates that 70% of patients have positive nodes cystoscopy was positive for metastatic carcinoma in the [2,5,6,12-151 (Table 2). This high rate of node positivity bladder and urethra. A femoral node biopsy was also must be considered in patients with adenoid cystic cervical positive for carcinoma. A suprapubic catheter was placed carcinoma. for long-term urinary drainage. By 10/82, she was noted Adenoid cystic carcinoma, usually seen in salivary to have circumferential tumor involvement of the vagina. glands and the respiratory tract, has also been reported She was admitted 1l/17/82 for dyspnea and severe anemia in skin, breast, and Bartholin’s gland. Extensive lymphatic and had bilateral ureteral obstruction. She was noted to and vascular involvement is common; perineural invasion have extensive paraaortic adenopathy on abdominal is also seen [8]. Vascular involvement was seen in all
FIG. 2. Vascular spaces, probably lymphatics, containing tumor, adjacent to medium-sized arteries (H&E x 100).
FIG. 3. Metastatic gland-forming carcinoma in peripheral sinuses of left obturator lymph node (H&E x40). 28
ADENOID CYSTIC CARCINOMA
29
OF CERVIX
TABLE 1 Adenoid Cystic Carcinoma of the Cervix in Women under Age 40 FIG0 stage
Therapy
Node Status
Outcome
Age
Race
Pt. No. 1 (MU3
24
W
GlPl
IB
RH, PLND 6 courses Chemotherapy
-
NED 12 months
Pt. No. 2 W3-3
38
b
G4P3Al
IB
RH, PLND
+
DOD 13 months
Pt. No. 3 (MCG)
27
W
G3PlA2
IB
RH, PLND 6 courses chemotherapy
+
NED 64 months
Pt. No. 4 (Hoskins et al.) [2]
31
W
GOP0
IB
RH, PLND pelvic XRT
+
NED 28 months
Pt. No. 5 (Hoskins et al.) [2]
33
W
G3P3
IB
RH, PLND pelvic XRT Cranial XRT
+
Brain and bone metastases DOD 29 months
Pt. No. 6 (Bag&h and Woodruff) [3]
39
B
GlPl
IB
TVH
Pt. No. 7 (Kovi) [4]
31
B
G7P6A 1
IIA
RH, PLND
Unknown
-
NED
Unknown
Note. RH, PLND, radical hysterectomy, pelvic lymphadenectomy; XRT, external radiation; TVH, total vaginal hysterectomy; MCG, Medical College of Georgia; DOD, dead of disease; NED, no evidence of disease.
three of our patients and has been reported by others [5,12,16]. The optimal primary treatment for early stage lesions is unknown. On the basis of a relatively high incidence of positive lymph nodes, vascular involvement, and distant metastatic disease, Fowler and associates recommended adjuvant chemotherapy IS]. They noted no response in two patients treated with bleomycin, 5-fluorouracil, and doxorubicin. Similarly, Hoskins et al. found little benefit from doxorubicin and cyclophosphamide [2]. Phillips and Frye, however, reported a complete response in one TABLE 2 Lymph Node Metastases in Stage 1 Adenoid Cystic Carcinoma of the Cervix Series Dinh and Woodruff [6] Hoskins et a/. [2] Audet LaPointe er al. [14] Fowler et al. [5] Miles and Norris [12] McGee et al. [15] Phillips and Frye [13] Medical College of Georgia Total
Patients with positive nodes 0 3 0 2 9 0 0 2 16
Total patients 1 4 1 2 10 1 1 3 23 = 70%
patient treated for recurrent adenoid cystic cervical carcinoma with nine courses of cisplatin, doxorubicin, and cyclophosphamide [ 131.The absence of disease at 12 and 64 months in two of our patients treated with relatively high dose cisplatin in an adjuvant setting suggests that this drug may have activity in patients with adenoid cystic tumors. Standard treatment for patients of all ages with adenoid cystic cervical cancer results in relatively poor survival. Prempree, in a recent review of 43 cases, noted a 56.2% 3- to 5-year survival for stage I disease, regardless of treatment modality [9]. Survival rate for all stages was 32.5% [9].
In summary, adenoid cystic carcinoma of the cervix is a rare neoplasm usually occurring in postmenopausal women. Vaginal bleeding and abnormal cervical cytology are the most common presenting complaints. Lymph node metastases are seen in a majority of patients with early stage disease, and vascular involvement is common. Chemotherapy regimens that utilize cisplatin may be a useful adjunct in the treatment of patients with adenoid cystic carcinoma of the cervix. REFERENCES 1. Paalman, R. J., and Counseller, V. S. Cylindroma of the cervix with procidentia, Amer. J. Obstet. Gynecol. 58, 184-187 (1949).
30
KING ET AL.
2. Hoskins, W. J., Averette, H. E., Ng, A. B. P., et al. Adenoid cystic carcinoma of the cervix uteri: Report of six cases and review of the literature, Gynecol. Uncol. 7, 371-384 (1979). 3. Baggish, M. S., and Woodruff, J. D. Adenoid-basal carcinoma of the cervix, Obstet. Gynecol. 28, 213-218 (1966). 4. Kovi, J. Adenoid cystic carcinoma of the cervix with myxochondroid change: Report of a case. Med. Ann. D. C. 41, 633-634 (1972). 5. Fowler, W. C., Jr., Miles, P. A., Surwit, E. A., Edelman, D. A., Walton, L. A., and Photopulos, G. J. Adenoid cystic carcinoma of the cervix. Report of 9 cases and a reappraisal, Obstet. Gynecol. 52, 337-342 (1978). 6. Dinh, T. V., and Woodruff, J. D. Adenoid cystic and adenoid basal carcinomas of the cervix, Obstet. Gynecol. 65, 705-709 (1985). Musa, A. G., Hughes, R. R., and Coleman, S. A. Adenoid cystic carcinoma of the cervix: A report of 17 cases, Gynecol. Oncol. 22, 167-173 (1985). Berchuck, A., and Mullin, T. J. Cervical adenoid cystic carcinoma associated with ascites, Gynecol. Oncol. 22, 201-211 (1985). Prempree, T., Villasanta, U., and Tang, C. K. Management of adenoid cystic carcinoma of the uterine cervix (cylindroma): Report of six cases and reappraisal of all cases reported in the medical literature, Cancer 46, 1631-1635 (1980).
10. Gonzalez, S. Adenoid cystic pattern in uterine cervical carcinoma: Report of three cases, J. Miss. State Med. Assoc. 25(8), 207-209 (1984). 11. Nel, C. P., and Tiltman, A. J. Adenoid cystic carcinoma of the uterine cervix: A report of two cases, S. Afr. Med. J. 53(26), 10731075 (1978). 12 Miles, P. A., and Norris, H. J. Adenoid cystic carcinoma of the ’ cervix: An analysis of 12 cases, Obsret. Gynecol. 38, 103-110 (1971). 13
Phillips, G. L., Jr., and Frye, L. P. Adenoid cystic carcinoma of the cervix: A case report with implications for chemotherapeutic treatment, Gynecol. Oncol. 22, 260-262 (1985).
14. Audet La Pointe, P., Vauclair, R., and Goeusse, P. A propos d’un cas de cylindrome du co1 uterin, J. Gynecol. Obstet. Biol. Reprod. 10, 203 (1981). 15. McGee, J. A., Flowers, C. E., and Tatum, B. S. Adenoid cystic carcinoma of the cervix: Report of a case, Obstet. Gynecol. 26, 356-358 (1965). 16. Mazur, M. T., and Battifora, H. A. Adenoid cystic carcinoma of the uterine cervix: Ultrastructure, immunofluorescence, and criteria for diagnosis, Amer. J. C/in. Pathol. 77, 494-500 (1982).