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Objective: The Silva invasion pattern-based classification system stratifies endocervical adenocarcinomas (ECAs) into 3 categories corresponding to risk of metastasis and recurrence, but has only been evaluated for HPV-associated ECAs of usual type. We examined whether the Silva system is applicable to all endocervical adenocarcinomas, especially those not associated with HPV., Methods: Complete slide sets from 341 surgical specimens of ECA were collected from 7 institutions worldwide. All specimens were associated with clinical records covering at least 5 years of follow-up. Tumors were classified as HPV-associated (HPVA) or not (NHPVA) by both morphology and detection of HPV using in situ hybridization. Recurrence and survival were analyzed by multivariate Mantel-Haenszel methods., Results: Most specimens (292; 85.6%) were HPVA, while 49 (14.3%) were NHPVA. All NHPVAs were Silva pattern C, while 76.0% of HPVAs were pattern C, 14.7% pattern A, and 9.3% pattern B. Including both HPVAs and NHPVAs, lymphovascular invasion (LVI) was detected in 0% of pattern A, 18.5% of pattern B and 62.6% of pattern C cases (p < 0.001). None of the pattern A or B cases were associated with lymph node metastases (LNM), in contrast to pattern C cases (21.8%). Among patients with Silva pattern C ECA, those with HPVA tumors had a lower recurrence rate and better survival than those with NHPVA; however, when adjusted for stage at diagnosis, the difference in recurrence and mortality was small and not statistically significant., Conclusions: Application of the Silva system is only relevant in HPVA cervical adenocarcinoma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The role of surgical resection of metastatic breast cancer to the abdomen and pelvis is controversial. The objective of this study is to describe the characteristics, surgical management, and outcome of women with a history of breast adenocarcinoma who developed abdominal or pelvic metastases during follow-up., Methods: We retrospectively reviewed the medical records of 40 female patients with documented invasive breast cancer who were referred to the Gynecology Service between 1986 and 1995 and were found to have metachronous abdominal and/or pelvic metastases., Results: The median patient age at exploration by the Gynecology Service was 53.5 years (range 27-79 years), and the median interval from breast cancer diagnosis to exploration was 80 months (range 9-264 months). The majority of patients, 32 (80%), had a preoperative diagnosis of a new pelvic mass or suspected abdominal carcinomatosis. With a median follow-up of 14.2 months following the diagnosis of abdominal or pelvic metastasis, the median survival for all patients was 24.1 months. Patients who had no gross residual disease in the abdomen or pelvis after surgery had a median survival of 41.6 months, which did not significantly differ from those with gross residual < or =2 cm (16.1 months) or >2 cm (18.4 months) (P = 0.624)., Conclusion: Metachronous abdominal and pelvic metastases from breast cancer may appear many years following initial diagnosis and are often operated on by gynecologists because of their clinical presentation. Surgical resection may be indicated in some symptomatic patients; however, the survival advantage of surgical cytoreduction remains to be determined.