Widespread lymph node metastases in a patient with microinvasive cervical carcinoma

Lymph node metastasis is uncommon in patients with microinvasive squamous cell carcinoma of the cervix and is particularly unusual in tumors with early stromal invasion. We describe a patient with maximum stromal invasion of 0.8 mm who had extensive pelvic and para-aortic nodal metastases discovered at laparotomy. Despite combined modality therapy, she died with progressive disease. New clinical staging definitions for Stage IA cervical carcinoma incorporate measurement of both depth of invasion and lateral tumor spread and have resolved many of the descriptive controversies surrounding this entity. Our case illustrates that any degree of stromal invasion carries some risk of nodal metastasis. The management of patients with microinvasive carcinoma should be individualized. An abdominal approach should be considered for patients being treated by extrafascial hysterectomy to allow assessment of the regional lymph nodes. Whether more aggressive therapy will influence the outcome for the rare patient with lymph node metastasis is unknown.