Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer

Spread into regional lymph node is the major route of metastasis in cervical cancer. Although lymph node status is not involved in the International Federation of Gynecology and Obstetrics staging system of uterine cervical cancer, the presence or absence of lymph node metastasis provides important information for prognosis and treatment. In this review, we have attempted to focus on the incidence and patterns of lymph node metastasis, and the issues surrounding surgical assessment of lymph nodes. In addition, the preoperative prediction of lymph node status, as well as the intraoperative assessment by sentinel nodes will be reviewed. Finally, lymph node micrometastasis also will be discussed.

Locally advanced cervical rhabdomyosarcoma in adults:A case report

BACKGROUND Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin,occurring predominantly in children and adolescents,but extremely rare in adults and the data regarding its treatment are sparse.Here,we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.CASE SUMMARY The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months.Physical examination revealed a friable,polyplike mass(5 cm×5 cm)in her cervix protruding into the vagina,while the uterus was mobile and normal-sized.Colposcopy-directed biopsy was performed,and a pathological diagnosis of embryonal rhabdomyosarcoma was made.Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased,with a hypointense and hyperintense soft tissue mass on the right side,invading the cervical stroma;the mass was 5 cm×5 cm with a clear boundary and confined to the cervix;there were no obvious findings indicating tumor invasion in the vaginal wall,parametrium,or pelvic wall;no enlarged lymph nodes were observed in the pelvic cavity.Based on our findings,the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3stage according to The International Federation of Gynecology and Obstetrics 2018.The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved.Subsequently,she underwent laparoscopic radical hysterectomy,bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination.Adjuvant chemotherapy was performed after surgery.The patient was disease-free until the last follow-up,49 mo after completing the entire treatment.CONCLUSION Our experience suggests that neoadjuvant vincristine,dactinomycin,and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire.Since large-scale studies on such rare conditions are rather impossible,further case reports and systematic reviews could help optimize the treatment of primary,bulky cervical rhabdomyosarcoma in adults.