High-grade CIN in pregnancy and post-partum period: a rare clinical association. New approaches

C. Maier, M. Comanescu, A. Poteca, R. Vladareanu, E. Bratila

Rezumat: Objectives. The purpose of this paper is to reassess the outcome of women diagnosed during pregnancy with high-grade cervical intraepithelial neoplasia (CIN 2/3) who benefited from a cervical excisional procedure in order to avoid the progression of the lesions towards invasive cervical cancer. We will also review the latest data from literature regarding the well-known complications of this type of treatment. Materials and methods. We will discuss the results of recent studies which question the present recommendations regarding CIN 2/3 management in early gestation and also the prognostic variables of cervical cancer diagnosed shortly after birth. We will report two clinical cases from our recent experience on this topic: the case of a 33-year-old patient in which the cervical citology result at pregnancy admission was HSIL and, respectively, the case of a 30-year-old patient in which the diagnosis of invasive cervical cancer was established at six months after birth. Results. The rate of spontaneous regression of CIN 2/3 appears to be lower than previously thought (especially in patients over 25 years old) and the rate of progression to cervical cancer varies between 2.7% and 9.7%. In addition, patients diagnosed with invasive cervical cancer in the postpartum period have worse survival rates than those diagnosed during pregnancy and are at higher risk of recurrent disease (particularly if they delivered vaginally). Conclusions. The delay in early diagnosis of a cervical lesion which is potentially curable can lead to invasive neoplasia, for which the therapeutic management is more complex.
Cuvinte cheie: CIN 2/3, pregnancy, LEEP, cervical cancer.