Annals of African Medicine Annals of African Medicine Society ISSN: 1596-3519 Vol. 5, Num. 3, 2006, pp. 118-121

Annals of African Medicine, Vol. 5, No. 3, 2006, pp. 118-121

Non-Squamous Cell Carcinoma of the Cervix in Zaria, Northern Nigeria:  A Clinico-Pathological Analysis

¹M. A. Abdul, ²A. Mohammed, ²A. Mayun and ¹S. O. Shittu

Departments of ¹Obstetrics and Gynaecology, and ²Morbid Anatomy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Reprint requests to: Dr. M.A. Abdul, Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. E-mail: Maabdul90@yahoo.com

Code Number: am06028

Abstract

Background: The incidence of Adenocarcinoma of the cervix is on the increase in many parts of the world. There is paucity of information regarding non-squamous cancer of the cervix in our setting.
Method:Descriptive analysis involving consecutive histological confirmed cases of non-squamous malignancy of the cervix over a ten-year period from January 1994 to December 2003.
Results: During the period of study, there were 361 histological confirmed cases of cervical cancer of which 322 (89.2%) were squamous cell carcinoma and 10.8% were non-squamous cell malignancy. All the 39 cases of non-squamous cell cancer except one were adenocarcinoma (97.4%). The exception was a case of leiomyosarcoma. Pure adenocarcinoma is the commonest form of adenocarcinoma (60.5%) followed by adenosquamous variant (21.1%). The mean age of the 39 patients was 42.9±7.2years (range 29 – 75 years) and mean parity of 5.5±2.9 (range 2 – 12). All the patients were symptomatic with abnormal uterine bleeding associated with vaginal discharge seen in 89.5% of cases. 80% of the patients were diagnosed in advanced stage.
Conclusion: Non-squamous cancer of the cervix constitutes 11% of all cervical malignancy in Zaria and adenocarcinoma is the commonest form. The clinical profile of adenocarcinoma of the cervix does not appear to differ from that of squamous cell cancer. Further studies are needed to compare the prognosis between the two histological cell types in our environment.    

Key words: Cervix, carcinoma, non-squamous

Résumé

Introduction : La fréquence des cas d’adénocarcinome de col est en augmentation dans bien des parties du monde.  Il y a une pénurie d’information en ce qui concerne cancer non squameux du col dans notre milieu.
Méthodes :Une analyse descriptive impliquant des cas maligns non squameux histologiquement confirmés de col au cours d’une période de dix ans à partir du janvier 1994 au décembre 2003.
Résultat :Pendant la période d’étude, il y avait 361 cas des cancers cervicaux histologiquement confirmés dont 322 soit 89,2% étaient cellulite carcinome squameuse et 10,8% étaient cellulite carcinome squameuse et 10,8% étaient cellulite malignité non-squameuse.  Tous les 39 cas du cancer de cellule non-squameux à l’exception d’un cas étaient adénocarcinome (97,4%).  L’exception était un cas de léiomyosarcome.  Adénocarcinome pur est une forme la plus ordinaire d’adénome carcinome 60,5% suivi par adénosquame variant (21,1%).  L’âge moyen de 39 patients était 42,9+-7,2 ans (tranche 2 – 12).  Tous les patients étaient symptomatiques avec l’utérin saignant anormal associé au écoulement/pertes vaginales vues chez 89,5 des cas.  80% des patients ont été diagnostiqués étape en avance.
Conclusion : Cancer de col non-squameux constitue 11% de tous les cas des maligns cervicaux à Zaria et adénocarcinome est la forme la plus ordinaire.  Le profil clinique d’adénocarcinome du col ne semble pas être différant de celui du cancer de la cellule squameuse.  Des études supplémentaires sont exigées afin de comparer le prognose entre les deux types des cellules histologiques dans notre milieu.

Mot clés :Col, carcinome, non-squameux

Introduction

Cervical cancer is a major public health problem in many developing countries, due largely due to limited access to screening and treatment.^{1, 2} Of the 400,000 new cases of cervical malignancy occurring annually worldwide, >80% occur in developing countries, 200,000 of whom die of the disease.^{2, 3}

In Sub-Saharan Africa, carcinoma of the cervix is the commonest genital tract malignancy encountered, accounting for over 50% of cases. ^4-7 Cancer of the cervix and breast, are the leading causes of cancer-related death among women in Africa.^{8, 9}

Squamous cell carcinoma is the commonest histological cell-type encountered accounting for over 85% of variants followed by adenocarcinoma. ^{10, 11} The incidence of adenocarcinoma has been on the increase partly due to increasing incidence of Human Papilloma Virus (HPV) infection and also due to increased detection of preinvasive and early invasive squamous cell carcinoma leading to a shift in histologic pattern in favour of adenocarcinoma.^{10, 12-18} Whether this trend is applicable to Sub-Saharan Africa is not clear as effective population-based screening is not widely available.

Most of the available reports that have characterised the pattern of cervical cancer in this environment have either focused on all cell types or the predominant squamous cell variant. Few reports have been directed at the less radiosensitive non-squamous cell types.  

Materials and Method

Consecutive histologically confirmed cases of cancer of the cervix from January 1994 – December 2003 were retrieved from the cancer register of the department of pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Cases of adenocarcinoma of the cervix and other non-squamous cell cancer were selected and case notes analysed.  The clinical profile and histological pattern of   these   cases   were   studied   including   those  of squamous cell carcinoma. Data was analysed using SPSS version 10.0.

Results

During the study period, there were 361 histologically confirmed cases of cervical malignancy of which 322 (89.2%) were squamous cell carcinoma and 10.8% were non-squamous cell cancer. Of the 39 non-squamous cell cases, 38 (97.4%) were adenocarcinomas and only one case of leiomyosarcoma. The histological variants of the 38 adenocarcinoma cases are shown in table 1. The mean age of the 39 patients with non-squamous cell carcinoma was 42.9 ± 7.2years (range 29-75) and mean parity of 5.5 ± 2.9 (range 2 – 12).  All the 39 patients were symptomatic, with abnormal uterine bleeding associated with vaginal discharge seen in 89.5% of cases. Four cases presented with post coital bleeding associated with gross lesion on the cervix.  The macroscopic features and Federation of International Gynecology and Obstetrics (FIGO) staging of the non-squamous cell cancers encountered is shown in tables 2; stage IB 3 (7.7%), IIA 5 (12.8), IIB 9 (23.1) and III 22 (56.4).  The cervical polyp was the only case of leiomyosarcoma encountered in the study. Squamous and non-squamous malignancies of the cervix are compared in table 3.

Table 1:  Histologic pattern of adenocarcinoma in 38 patients

Table 2: Summary of gross features and histologic type of non-squamous cell carcinoma of the cervix

Table 3: Comparison of clinico-pathological features of squamous and non-squamous malignancies of the cervix

NS: not significant; FIGO: Federation of International Gynecology and Obstetrics

Discussion

The mode of clinical presentation and staging in the present report do not differ from established data concerning cancer of the cervix in Africa. ^19-24  In this study, mean age at presentation was 43 years, abnormal uterine bleeding with vaginal discharge were present in 90% of cases and 80% were diagnosed with advance disease (≥stage II B). These characteristics were similar with that of squamous cell carcinoma (table IV). Thus it appears that in terms of mode of presentation and staging, non-squamous cell cancer (adenocarcinoma) do not differ from squamous cell carcinoma in our setting.  Non-squamous cell carcinoma accounts for 10-22% of all cervical cancers while squamous cell type accounts for the remainder (80-90%). Our figure of 11% for non-squamous cell carcinoma confirmed earlier reports.^{10-11, 25}  

In this study, adenocarcinoma is the predominant tumour type (97%) for non-squamous cancers, and 61% of adenocarcinomas were well differentiated (pure) adenocarcinomas followed by adenosquamous variant (21%).  Others such as papillary serous and clear cell carcinoma were not common.  This is in conformity with established knowledge.^{10, 11} Only one case of sarcoma of the cervix was encountered in this study. Lymphomas, melanomas or basal cell carcinoma were not seen among our patients.  It can be concluded that adenocarcinoma is the prototype of non-squamous cell malignancy of the cervix and the clinical profile (presentation and staging) of patients with cervical adenocarcinoma do not appear to differ from that of squamous cell cancer in our setting. Further studies are needed to compare the prognosis between the two histological cell types in our environment.

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