What are the other Names for this Condition? (Also known as/Synonyms)

• Postoperative Cervical Pseudosarcoma
• Postoperative Spindle-Cell Nodule of Cervix
• PSCN of Uterine Cervix

What is Postoperative Spindle-Cell Nodule of Uterine Cervix? (Definition/Background Information)

• Postoperative Spindle-Cell Nodule of Uterine Cervix is a very rare and benign tumor that forms due to an injury (tissue damage); particularly because of a surgical procedure involving the female genital tract. It is generally observed in young and middle-aged women
• Postoperative Spindle-Cell Nodule of Cervix can appear within a few weeks to a few months following the surgical procedure. It forms at the site of the surgery as a benign reactive lesion
• The tumor is also known as a postoperative pseudosarcoma, since it resembles a sarcoma, which is a malignant tumor. This can lead to misdiagnosis and over-treatment of Postoperative Cervical Spindle-Cell Nodule. For this reason, it is important that a healthcare provider carefully examine and recognize the condition (i.e., postoperative spindle-cell nodule or PSCN)
• The tumor appears as a solitary and reddish nodule with poorly or well-defined borders. These tumors are frequently associated with bleeding
• The treatment course may include a ‘wait and watch’ approach or a surgical excision and removal of the lesion. In general, the prognosis of Postoperative Spindle-Cell Nodule of Uterine Cervix is excellent with suitable treatment, but the tumor is known to recur locally

Who gets Postoperative Spindle-Cell Nodule of Uterine Cervix? (Age and Sex Distribution)

• Postoperative Spindle-Cell Nodule of Uterine Cervix is a very uncommon tumor that is generally observed in young and middle-age women (around 25-50 years)
• Nevertheless, females of any age category may be affected
• There is no known ethnic or racial preference

Overall, considering the general incidence of PSCN, it is more common in males than females with a male-female ratio of 3:1.

What are the Risk Factors for Postoperative Spindle-Cell Nodule of Uterine Cervix? (Predisposing Factors)

Any surgical procedure performed involving the female genital tract can be a potential risk factor for Postoperative Spindle-Cell Nodule of Uterine Cervix. Such invasive procedures may include any of the following:

• Hysterectomy: A partial or complete removal of the uterus
• Episiotomy: A minor surgical procedure to widen the opening of the vagina during childbirth
• Dilatation and curettage: The procedure involves opening the cervix and surgically removing the inner lining and tissue present in the uterus

A past history of postoperative spindle-cell nodule either at the same site or other location may increase the risk; this implies that some individuals are more prone to development of this reactive tumor.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postoperative Spindle-Cell Nodule of Uterine Cervix? (Etiology)

• Currently, the exact cause and mechanism of formation of Postoperative Spindle-Cell Nodule of Uterine Cervix is unknown
• The tumors are seen to form as a reactive process at the site of surgical injury or trauma

What are the Signs and Symptoms of Postoperative Spindle-Cell Nodule of Uterine Cervix?

The signs and symptoms of Postoperative Spindle-Cell Nodule of Uterine Cervix may include:

• Small tumors usually do not cause any symptoms and may remain unnoticed/undetected
• The reactive lesions (fibrous tissue) form at the site of trauma/surgery and can be nodular in shape. The lesions are known to grow and develop rapidly
• In a majority of cases, the time period between the surgical procedure and formation of the reactive lesion in the cervix ranges from 14 days to 90 days
• The borders of the nodules may be well-defined or irregularly-defined
• The lesions are commonly red in color and inflamed
• The size of the tumors may be a few centimeters (2-3 cm generally)
• These postoperative spindle-cell nodules show ulceration in most cases
• Some may be swollen with fluid; many lesions are known to bleed (hemorrhage)
• Pain during sexual intercourse; bleeding after sex
• Pain in the genital tract may be observed in some cases

Note: But for metastasis, a postoperative spindle-cell nodule is similar to a sarcoma (a malignant tumor with infiltrative margins), both in behavior and on a histopathological evaluation.

How is Postoperative Spindle-Cell Nodule of Uterine Cervix Diagnosed?

A diagnosis of Postoperative Spindle-Cell Nodule of Uterine Cervix may involve the following steps:

• Complete physical and pelvic examination and evaluation of the individual’s medical history: In order to establish a diagnosis of a Postoperative Cervical Spindle-Cell Nodule, a history of a prior surgical procedure/operation at the site of the tumor is key
• Ultrasound scan of the pelvis: It is a noninvasive procedure that uses high frequency sound waves to produce real-time images
• Abdominal and pelvic CT scan: It is a noninvasive procedure that provides more details of soft tissues, blood vessels, and internal organs
• Pelvic MRI scan: It is a noninvasive medical test that uses a powerful magnetic field to produce images of soft tissues, bones, organs, and all other internal structures of the abdomen and pelvis
• Hysteroscopy: This procedure involves placing a probe through the cervix to examine the cavity of the uterus
• Colposcopy:
  • The cervix is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
  • In order for this procedure to be performed, the individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside

Tissue biopsy of the mass:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Note:

• A Postoperative Cervical Spindle-Cell Nodule shows sarcomatoid features (sarcoma resemblance), both in terms of behavior and morphologically. The healthcare provider should be aware of such tumors and the nature of these tumors, in order to make an accurate diagnosis. Otherwise, it can lead to an incorrect diagnosis and over-treatment of this benign tumor
• A postoperative spindle-cell nodule (PSCN) is also known to be histologically similar to inflammatory myofibroblastic tumor (IMT). IMTs are benign tumors with aggressive behavior that can occur anywhere in the body. However, unlike PSCNs, IMTs are not seen against a background of trauma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postoperative Spindle-Cell Nodule of Uterine Cervix?

Significant complications from Postoperative Spindle-Cell Nodule of Uterine Cervix are generally not noted. However, the following may be observed in some cases:

• Stress due to a concern for cervical cancer
• Severe pain and bleeding during sex may occur
• Tumor masses bleed may get secondarily infected with bacteria or fungus
• Providing inappropriate or ineffective treatment due to misdiagnosis of the tumor as a sarcoma
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication
• Local recurrence of the tumor after its surgical removal is known to occur

How is Postoperative Spindle-Cell Nodule of Uterine Cervix Treated?

Treatment measures for Postoperative Spindle-Cell Nodule of Uterine Cervix may include the following:

• Majority of asymptomatic tumors are not surgically removed: The healthcare provider may recommend a ‘wait and watch’ approach for small-sized tumors presenting mild (or no) signs and symptoms, after a diagnosis of postoperative spindle-cell nodule is established
• Surgical intervention with complete excision may result in a complete cure. Advanced surgical techniques may help decrease the incidence of recurrence after removal of the lesion
• Post-operative care is important: Minimum activity level is to be ensured until the surgical wound heals
• Follow-up care with regular screening may be recommended by the healthcare provider

How can Postoperative Spindle-Cell Nodule of Uterine Cervix be Prevented?

• The development of reactive lesions, such as due to surgical trauma, is difficult to predict. Currently, no specific measures are available to prevent the formation of Postoperative Spindle-Cell Nodule of Uterine Cervix
• However, prompt treatment may help in decreasing the amount of fibrous tissue formation at the site of surgery

What is the Prognosis of Postoperative Spindle-Cell Nodule of Uterine Cervix? (Outcomes/Resolutions)

• The prognosis of Postoperative Spindle-Cell Nodule of Uterine Cervix is excellent with appropriate treatment, since it is a benign tumor
• However, the tumor is known to locally recur, and hence, close follow-up may be necessary

Additional and Relevant Useful Information for Postoperative Spindle-Cell Nodule of Uterine Cervix:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/