Enhancing Early Detection and Management of Cervical Glandular Neoplasia Through Colposcopy

Early detection and treatment of cervical carcinoma are critical, however, patients in low- and middle-income countries (LMICs) often present at advanced stages due to inadequate screening, low awareness, and insufficient diagnostic facilities. Training healthcare professionals in colposcopy and biopsy techniques can enhance early diagnosis by evaluating the type and extent of cervical disease. It is less frequent to find adenocarcinoma in-situ (AIS), especially when it is not associated with squamous lesions. Invasive adenocarcinoma is more common in younger people and has a greater recurrence rate than squamous cell carcinoma, which emphasises the need for specialised treatment approaches.

The World Health Organization categorizes endocervical glandular lesions as endocervical glandular dysplasia (EGD) and AIS. Adenocarcinomas are classified based on their association with human papillomavirus (HPV), influencing prognostic outcomes. The Silva pattern of glandular invasion has been pivotal in developing prognostic classifications for glandular adenocarcinoma.

The current case study presented a 45-year-old woman who was HPV 16 positive and had intermenstrual bleeding. Her colposcopic findings revealed a large ectropion like lesion on the columnar epithelium with clumping of columnar papillae, on the anterior cervix, the squamocolumnar junction was well defined, indicative of invasive adenocarcinoma. The lesion exhibited distinct vascular patterns and acetowhite changes, leading to a diagnosis of adenocarcinoma after biopsy. Following a type 2 radical hysterectomy, the patient received adjuvant radiation and histopathology showed type b Silva pattern of invasion with tumour size of 3.5 cms, with no involvement of lymph node. Adjuvant radiation was therefore administered while taking intermediate risk factors into account. After a year of follow-up, the patient is fully disease-free and has received hormone replacement treatment.

Routine screening methods like cytology and visual Inspection with acetic acid (VIA) are less sensitive for detecting glandular neoplasia. HPV testing can aid in identifying AIS when cytology fails. Thus, considering colposcopy into screening programs is necessary for enhancing diagnosis and treatment outcomes in cervical glandular neoplasia.

Source:  Singh P, Colposcopic features of HPV associated adenocarcinoma usual type. Indian J Obstet Gynecol Res. 2024;11(3):511-514