8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.104 Microinvasive cancer. Nest of invasive cancer within 5 mm
from the basal layer of the overlying epithelium (H&E x LP).
and the lymphatic channel involvement. The single most
important histologic parameter for prognostication of micro-
invasive cancer is the extension of tumor growth into capillary-
like spaces (lymphatic channels or microarterioles).207 Of less
importance in the determination of prognosis are the growth
pattern of the lesion and the host's immune response to the
tumor. Confluence of invading foci seems to be of relevance
only for prognosis, where it contributes to the overall extent
of the tumor.82 A diagnosis of invasion of capillary-like spaces
should be supported by the presence of an endothelial lin-
ing of these spaces and a continuous growth from the tumor
into such a space201 (Fig. 8.105). In many specimens, tumor
cell nests are found in tissue spaces. These, however, lack an
endothelial lining; there is no evidence of a continuous growth
from the tumor into these spaces. They are the result of shrink-
age of the stroma during fixation. Ferenczy believes that true
involvement of capillary-like spaces should exclude the tumor
from the category of microinvasive cancers, irrespective of the
depth of invasion.208 Ng and Reagan5,194 reviewed the frequency
of lymph node metastasis of 96 women who had had hyster-
ectomy and radical lymph node resection. With a depth of
infiltration less than 1 mm, no lymph node metastases were
found. With a depth of infiltration of 1-5 mm, the frequency
of lymph node involvement increased from 3.2 to 11.1%. In
the total group, metastatic spread to lymph nodes was found in
4% of cases. Burghardt found no recurrent cancers after 3 to 11
years of follow-up in nine cases with early stromal invasion of
microinvasion up to 5 mm and in all cases with involvement
of capillary spaces.201 Roche and Norris found no spread to
lymph nodes in 30 cases with microinvasion of 2-5 mm (aver-
age 3.2 mm) in depth.207 In 57% of these women, capillary-like
space involvement was found. Seski and colleagues reported on
lymph node involvement in one of four women with microinva-
sion up to 3 mm and capillary-like space involvement, whereas
in a group of 37 women with comparable depth of invasion
but without capillary-like space involvement, lymphatic spread
could not be demonstrated.209 Although the results of these
studies are conflicting, capillary-like space involvement should
be considered an important risk factor and warrants more
radical treatment.82,196
Fig. 8.105 Microinvasive cancer: invasion of capillary-like space. Tumor
cells invading luminal space lined in part by endothelial cells and in part by
tumor cells (H&E x HP).
Cytology
Cytologic features consistent with microinvasive cancer are still
very difficult to interpret. Many investigators emphasize that a
diagnosis of microinvasive carcinoma cannot be reliably made
from a cytologic specimen. However, some cytologic features are
strongly associated with a more advanced epithelial abnormal-
ity than that of a CIN grade 3 type of lesion.
A rrangem ent o f Cells
Cells are often arranged in syncytial aggregates (Fig. 8.106). In
microinvasive carcinoma, the number of abnormal cells on the
average is lower than in outright invasive cancer.
N uclear M orphology
Nuclear chromatin is more often uniformly finely or coarsely
granular and less often irregularly distributed or opaque than
in outright invasive cancer (Fig. 8.107). Nucleoli are usually
found, but macronucleoli are infrequent (Fig. 8.108). The most
consistent nuclear feature associated with invasive growth is the
appearance of irregularly shaped nucleoli, together with a rela-
tive increase in the amount of cytoplasm.
187
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