504 Challenges in diagnosis of cervical adenocarcinoma in a patient with uterine malformation: a rare case report

• Published in: International journal of gynecological cancer Vol. 31; no. Suppl 3; p. A30
• Main Authors: Álvarez Sánchez, S, Barreiro García, JM, Marti Sopeña, M, Delgado Espeja, JJ, Solano Calvo, JA, Goñi, Á Zapico
• Format: Journal Article
• Language: English
• Published: Oxford BMJ Publishing Group Ltd 12.10.2021; BMJ Publishing Group LTD
• Subjects: Biopsy; Case reports; Cellular biology; Cervical cancer; Endometrium; Human papillomavirus; Uterus; Vagina
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1136/ijgc-2021-ESGO.38

Introduction/Background*Cervical cancer is the fourth most common cancer of women in the world. Some risk factors for cervical adenocarcinoma are shared with squamous cell carcinoma, mainly infection with high-risk subtypes of human papillomavirus (HPV).MethodologyA 69-year-old woman suffered recurrent postmenopausal bleeding for 2 years. Medical and surgical history: a right radical nephrectomy due to congenital renal atrophy and a partial removal of a rudimentary uterus during a c-section.Initial medical research showed no pathology, including double liquid-based cytologies with negative result to HPV. During the follow-up period, a solid excrecent mass was discovered protruding into vagina.Result(s)*The vaginal biopsy diagnosed a papilar adenocarcinoma of clear-cells. A computed tomography and nuclear magnetic resonance revealed a 5cm solid mass located in the right sided genital system. A hysteroscopic study was also performed and revealed no lesions in vagina but a double cervix and uterus. The left-sided hemiuterus presented an atrophic endometrium, and the right-sided hemiuterus showed a proliferative endometrium. The endometrial biopsy revealed also a papilar adenocarcinoma of clear-cells with immunohistochemical study that suggested the cervical origin.The interdisciplinary tumour committee considered the case as a cervical cancer stage IIIB, performing the paraaortic lymphadenectomy by laparoscopic surgery (negative for malignancy) and subsequently, chemoradiotherapy.Conclusion*The difficulty of diagnosis in cervical adenocarcinoma lies in the cytology; the lack of sensitivity to adenocarcinoma may be due to these cancers developing in the endocervical canal, making sampling of abnormal cells difficult.Clear-cell carcinoma comprises approximately 3% of all cervical adenocarcinomas and is aetiologically unrelated to HPV infection.This case highlights some points of technical difficulties to resolve the diagnosis. First, the genital malformation that created obstacles to diagnose the origin of the pathology. Secondly, the negative result to HPV. Lastly, the unusual subtype of cervical adenocarcinoma and its predicament connected with the diagnostic sensitivity in the cytology.