Cervical Cancer Complexity: Exploring the Coexistence of CIN3 and Glandular Lesions

Although cases of squamous cell carcinoma of the cervix are declining, the increase in adenocarcinoma and in situ adenocarcinoma raises new concerns and requires improvements in diagnostic and therapeutic strategies. This study investigates the relationship between advanced CIN3 and concurrent cervical glandular diseases, emphasising the importance of high-risk HPV genotypes in the progression of these conditions.

The clinical data of 104 patients who underwent conization for CIN3 at our centre in the last 10 years were reviewed. Cytological and histological diagnoses were performed according to the 2014 Bethesda system and WHO classification criteria, respectively. The analysis included patient age, HPV genotype of the surgical specimen, length of the cone, resection margin status, and follow-up details.

Of the 104 patients, 92 (88.46%) were diagnosed with single CIN3 lesions (group 1), while 12 patients (11.54%) had coexisting glandular CIN3 lesions (group 2). All women tested were found to be positive for high-risk HPV (HPV-HR). The HPV18 genotype was found to be statistically more prevalent in group 2 (41.7%) than in group 1 (13%) (p = 0.011). At the first follow-up, HPV persistence was observed in 14/92 (15.2%) patients in group 1 and 10/12 (83.3%) patients in group 2 (p= 0.00001). Finally, the recurrence rate was 6.5% (6/92) in group 1 vs 30% (3/10) in group 2 (p= 0.012).

In the management of cervical lesions, glandular pathology may go undetected at initial diagnosis, as it is often not visible on colposcopy or cytology. It is only through excisional treatment, which allows a more detailed analysis of the tissue, that these lesions can be identified. The presence of an associated glandular lesion radically changes the clinical picture and therapeutic management, requiring a more radical approach than that expected for an isolated CIN3 lesion.

The results of the study not only highlight the complexity of CIN3 associated with AIS/AC lesions, but also the importance of an integrated strategy that includes early diagnosis, appropriate treatment, and rigorous follow-up. The ultimate goal is the improvement of clinical outcomes and quality of life for cervical cancer patients.