Introduction The incidence of cervical adenocarcinoma in situ (AIS) has recently risen in reproductive-age women. This study aimed to investigate the effects of various factors such as Pap smear, HPV, margin status, ECC, and crypt involvement on the residue of disease and outcomes of patients with AIS.

Methods This study was conducted on 22 women with cervical AIS who were treated in a tertiary hospital, between 2004 and 2022.

Results In this study, 22 women with AIS which was diagnosed in cone biopsy (84% in loop electrosurgical excision procedure and 16% in cold knife cone method), underwent hysterectomy. Positive internal and external margins were noted in 45.0% and positive internal margins in 9% of patients. Residual disease was detected in 7 (31%) patients; three of them had invasive carcinoma. In patients with invasive carcinoma, one had positive internal and external margins and ECC, and two others had positive internal and external margins. Although, CIN3 and SCC were noted in 3 and 1 patients of negative margins, respectively.

Conclusion/Implications The results of this study indicated that hysterectomy should be recommended even in patients with negative margins; and in women with positive margins (internal or external), the re-cone biopsy should be performed before hysterectomy to detect invasive carcinoma.