Pregnancy after several surgical treatments of adenocarcinoma in situ of the uterine cervix

INTRODUCTION: Adenocarcinoma in situ (AIS) is the only known precursor to adenocarcinomas of the uterine cervix that is possible to detect thus prevent progression of the disease. Although the incidence of AIS is still relatively low, it increased 6 times in the period between 1970's and 1990's. Increase of HPV-18 infections and oral contraceptive use are considered to be main causes of the inclined incidence of cervical AIS. AIS has been difficult to detect both cytologically and colposcopically. Spare surgical treatment requires long-term clinical observation and control due to the risk of residual or recurrent disease, even in patients with negative conization margins. CASE REPORT: We are presenting a case of management and control of cervical AIS in a thirty-year-old nullipara. During regular cytological screening the patient was diagnosed with LSIL, according to 2001 Bethesda classification. Cryosurgery was performed. Control PAP smear showed HSIL and HPV-18 was identified by genotyping. Colposcopical exam showed G2, type III change, biopsy confirmed CIN III and cervical canal biopsy was negative. Loop excision of the transformation zone (LETZ) and the biopsy of the residual cervical canal were then performed. Biopsy then showed CIN II with adenocarcinoma in situ with positive margins. There were no changes diagnosed in the cervical canal. Cold knife reconization was then performed and adenocarcinoma in situ with positive endocervical margin was found. Again there were no neoplastic changes in the cervical canal. Possible recurrent disease has now being prevented by regular controls (ultrasound, cytology, colposcopy, histology). Along with cervical disease controls, patient underwent fertility procedures and treatment. A year after the last cone biopsy, due to the cervical stenosis and hematometra, dilation of the cervical canal was performed and histology of endometrium and endocervical canal showed no recurrent disease. Three months later pregnancy after fertility treatment was verified. The patient is now 16-week pregnant. This case showed that teamwork of gynaecologic oncologist, cytologist, pathologist and gynaecologic endocrinologist can result in spare treatment and much wanted pregnancy.