Adenocarcinoma in Situ of the Uterine Cervix

Abstract

Adenocarcinoma in situ (AIS) of the uterine cervix has been acknowledged as a precursor lesion of invasive adenocarcinoma. AIS is histologically characterized by the presence of endocervical gland lined by atypical endocervical epithelium resembling the cells of adenocarcinoma but has no evidences of stromal invasion. AIS occurs within the endocervical clefts, it is difficult to screen cytologically. Incorporating high-risk HPV-DNA testing into cytologic screening could better identify AIS lesion. For definitive diagnosis of AIS, cervical conization either with knife, electrical loop, or laser is required to ensure the exclusion of coexisting invasive adenocarcinoma. Hysterectomy remains the most preferred method of definite treatment. Conservative management by conization alone is only acceptable for whom preservation of fertility is an issue. The occurrences of recurrent or persistent disease for women treated for AIS are mostly noted during the first 3 years of follow-up emphasizing the necessity of extensive surveillance in this period.