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Objective: To analyze the clinicopathologic features of mucinous cervical adenocarcinoma (ADC) and supply some reference for its diagnosis, treatment and prognosis., Methods: Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved. Their clinical and pathological data were reviewed and analyzed., Results: Among 88 patients, 70 cases of them were endocervical ADC, 11 cases were minimal deviation adenocarcinoma (MDA), 2 cases were intestinal subtype and 5 cases were villoglandular ADC. The positive rate of cervical Pap smear cytology was only 28% (10/36). There were 10 cases were performed several times of cervical Pap smear cytology test and biopsies, while still no abnormality was found. Finally, 7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage, including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases (1 case with stage Ib1 endocervical ADC and 1 case with Ib1 MDA) were diagnosed by cold knife conization, and 1 case with stageIb1 endocervical were diagnosed by uteroscopically directed biopsy. The overall 5-year survival rate was 60.0%. Using univariate analysis results showed that age (P = 0.046), stage (P = 0.007), tumor size (P = 0.007) and therapeutic methods (P = 0.009) were significant prognostic factors. Multivariate analysis showed that therapeutic methods was an independent predictor for survival (P = 0.013). Stage IIb-IIIb MDA patients occupied 7/11 of all MDA patient, while there was only one such patient of 5 cases with villoglandular ADC. The overall HPV infection rate was 65% (57/88), and there was no obvious differences about the HPV infection rates among different types of mucinous ADC., Conclusions: Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma. Early stage mucinous ADC is difficult to be detected, especially for MDA. Cervical excisional biopsy, endocervical curettage, cold knife conization, uteroscope are beneficial to its diagnosis. Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.

Objective: To compare the rate of surgical complications and surgical failure of different surgical treatments in cervical intraepithelial neoplasia (CIN) III., Methods: From Jan 2002 to Jun 2007, 1256 patients with CIN III confirmed by histopathologic punch biopsy and excision biopsy of cervical specimens were analyzed retrospectively. Among them, 74 patients accepted loop electrosurgical excision procedure (LEEP), 869 patients adopted cold knife conization (CKC), 49 patients received vaginal enlarged amputation of cervix, as well as 264 patients accepted external fascia hysterectomy, Chi-square test was used to compare the rate of surgical efficacy and complications of different surgical treatments., Results: The surgical failure incidence of LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy were 4.1% (3/74), 0.2% (2/869), 0 and 0.4% (1/264) respectively, which was significantly higher in LEEP than that in CKC (P = 0.004) and external fascia hysterectomy (P = 0.034), while there was no statistical difference between CKC and external fascia hysterectomy (P = 0.549). The rate of surgical complications of LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy were 8.1% (6/74), 6.2% (54/869), 6.1% (3/49) and 2.3% (6/264) respectively, which were not statistically significant (P = 0.067) among them., Conclusion: LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy are all secure and effective procedures for patients with CIN III, who can take the individual choice depending on their different conditions.

Objective: To analyze the changes in epidemiology and treatment of hospitalized patients with cervical cancer during 1990-2007., Methods: Overall, 4648 patients with cervical cancer were diagnosed in our hospital from Jan 1990 to Nov 2007, but only 4223 patients with initial treatment in our hospital were studied retrospectively. Pearson Chi-square test was used to compare the age, stage, histopathologic type and treatment methods between different times., Results: (1) The mean age of cervical cancer patients gradually decreased over the past 18 years, from 54.4 years during 1990-1999 to 47.2 years during 2000-2007; the proportion of young patients aged < or = 35 years increased from 4.77% (89/1865) during 1990-1999 to 11.75% (277/2358) during 2000-2007. (2) The proportion of patients with cervical cancer (stage I a-II a) increased from 14. 32% (267/1865) during 1990-1999 to 40.75% (961/2358) during 2000-2007, whereas the proportion of patients with cervical cancer (stage II b-IV) decreased from 85.68% (1598/1865) during 1990-1999 to 59.25% (1397/2358) during 2000-2007. (3) There was no significant change in histopathologic type of cervical cancer, and squamous cell carcinoma of cervix remained the main type of cervical cancer. (4) The treatment pattern of cervical cancer changed significantly: radiotherapy was the main method (75.28%) for cervical cancer during 1990-1999, but during 2000-2007, it was replaced by concurrent chemoradiotherapy (35.79%)., Conclusions: The proportion of young women with cervical cancer was increased during 1990-2007, and at the same period early stage cervical cancer increased, but late stage cervical cancer decreased. It is obvious that chemotherapy has become the important therapy in cervical cancer.

Objective: To evaluate the feasibility and safety of vaginal enlarged amputation of cervix to treat patients with cervical cancer of stage Ia1 and cervical intraepithelial neoplasia grade III (CIN III) who were unfit for conization surgery., Methods: From July 2002 to May 2007, patients with cervical cancer at stage Ia1, diagnosed by pathology after loop electrosurgical excision procedure (LEEP), large area CIN III (the area of lesion>or=3/4 on colposcopy), CIN III coexisted with vaginal intraepithelial neoplasia (VAIN) in the superior segment of vagina, CIN II-III recurrence or with residual lesion, positive margin after conization of cervix, who wanted to preserve fertility and (or) corpus uteri were selected to receive vaginal enlarged amputation of cervix., Results: Forty-eight cases including 5 with cervical cancer in stage Ia1, 38 with large area CIN III (9 with gland involvement), 2 with residual lesion and 2 with positive margin after LEEP, 1 recurrence after cold knife conization, received the procedure successfully. The median age was 34 years (range 27-40), median operation time was 60 minutes (range 30-100), median blood loss was 40 ml (range 5-300), and median hospital stay was 10 days (range 7-17). After follow-up 1-39 months, no patient had postoperative complications and recurrence, and all patients resumed normal menstrual cycle and sexual life., Conclusion: Vaginal enlarged amputation of cervix appears to be a safe and feasible procedure for patients with cervical cancer at stage Ia1 and CIN III who are unfit for conization surgery.