The multicentric origin of carcinoma in situ of the cervix

THE MULTICENTRIC OF THE CERVIX

ORIGIN

OF CARCINOMA

IN SITU

Case Report A. M. COLUMBUS,

(From

the

Department

of Obstetrics

BRINGARDNER,

M.D.,

AND

ALEXANDER

HORAVA,

M.D.,

OHIO

atsd

Gynecology,

The

Ohio

State

University

Hospital)

T

HE multicentricity of carcinoma of the cervix is occasionally mentioned in the current literature on the subject. Most authors seem to accept this postulate, but the evidence for it is scanty. The purpose of this case report is to present supportive evidence for the supposition of a multicentric origin of carcinoma in situ of the cervix and to demonstrate that in this case a conization of the cervix would have been inadequate as a curative procedure. Mrs. N. G., Hospital No. 598787, was a 34-year-old white woman, gravida ii, para i, abortion i, who consulted her family physician 2 months prior to admission because of constipation. At that time a routine pelvic examination including a Papanicolaou test was done and a suspicious lesion of the cervix was cauterized. The smear was reported as suspicious of malignant process of the cervix and the patient was referred to The Ohio State University Cancer Clinic where a cervical biopsy was done on Oct. 9, 1956. Following the biopsy, the patient bled profusely and was admitted to the University Hospital on Oct. 13, 1956. A cold-knife conization and dilatation and curettage were done. Both the previous biopsy and conization specimen were reported by the pathologist as carcinoma in situ of the cervix. On NOV. 4, 1956, she was readmitted to the hospital and a total abdominal hysterectomy including removal of a vaginal cuff was performed. The postoperative course was uneventful. Pathological Examination.-The first biopsy specimen consisted of fragments of cervical squamous epithelium with focal cellular pleomorphism, lack of maturation, and crowding of This was interpreted as indicative of carcinoma in situ. The second diagnostic the cells. procedure, namely, a wide and deep cervical cold-knife conization, revealed a circumscribed plaque of cervical carcinoma in situ flanked from below by normal squamous epithelium and from above by normal columnar endocervical epithelium. Because of an identical picture in all step sections throughout the conization specimen, one would be tempted to conclude that Later the hysterectomy specimen the lesion (carcinoma in situ) had been completely excised. displayed a baffling picture. The distal portion of the endocervical canal and the cervix itself showed granulation tissue covered partially by a regenerating normal ecrvical epithelium This was the site of the previous cold-knife conization. No (Figs. la, lB, lC, and 2). residual carcinoma in situ was found here. The upper portion of the endocervical canal was lined by entirely normal columnar epithelium (Figs. 1D and IE) ; but high up and in close proximity to the internal os another focus of squamous-cell carcinoma in situ was found (Figs. 1F and 3) surrounded by normal intact columnar epithelium. Because this lesion was found within normal noninjured endocervical tissue, the conclusion was made that this lesion seated high in the endocervical canal represented another focus of carcinoma in situ. The finding

1304

BRINGARDNER

AND

that this focus was indeed surrounded by normal mucosa justifies the concIusion of a multicentric of the cervix in this case.

Summary

Am. J. Oh.

HORAYA

nonregenerating origin of the

& Gytxc. June, 1958

and noninjured endocervical squamous-cell carcinoma in situ

and Conclusions

A case is presented of carcinoma in situ of the cervix detected by routine Papanicolaou smear, diagnosed by punch biopsy and cold-knife conization of the cervix, and treated by hysterectomy. Examination of the tissue removed gives evidence for the postulate of a multicentric origin of carcinoma in situ of the cervix and indicates that treatment by conization alone may not be sufficient for the removal of all malignant squamous epithelium in this disease. We wish

to thank

Dr.

William

E. Copeland

for

permission

References 1. Carson, 2. Foote,

R. P., and Gall, E. A.: Am. J. Path. 30: 15, 1954. F. W., and Stewart, F. W.: Cancer 1: 431, 1948.

to report

this

case,