Abstract
Ichthyosis uteri is an exceedingly rare condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium. Originally described as an endometrial response to iatrogenically-introduced caustic substances, similar changes have since been described in association with a variety of inflammatory conditions of the endometrium. We describe herein a heretofore undescribed example of a moderately differentiated squamous cell carcinoma of the uterine cervix associated with extensive ichthyosis uteri-like changes of the entire adjacent endometrium. Additionally, the squamous epithelium of the latter also showed multifocal changes diagnostic of a low-grade squamous intraepithelial lesion. The potential genesis of this composite of findings is discussed, as is the neoplastic potential of ichthyosis uteri. It is concluded that a squamous cell carcinoma of the cervix extended proximally into the endometrium, and that there was a colonization of a pre-existing ichthyosis uteri by associated human papillomavirus. The possibility of significant cervical pathology should be considered when plaques of squamous epithelium with low grade dysplastic changes are identified in an endometrial biopsy or curettage.
Highlights
A 38-year-old nulligravid female presented with complaints of a vague pelvic heaviness and a vaginal discharge
The term "ichthyosis uteri" was initially coined in 1885 by Zeller to refer to extensive squamous metaplasia of the surface endometrium following iatrogenically-introduced caustic substances such as formalin or iodine [2]
The second potential explanation is that within a background of extensive ichthyosis uteri, a squamous cell carcinoma developed in the lower uterine segment
Summary
The term "ichthyosis uteri" was initially coined in 1885 by Zeller to refer to extensive squamous metaplasia of the surface endometrium following iatrogenically-introduced caustic substances such as formalin or iodine [2]. An argument can be made for a purely lepidic, surface extension of a cervical squamous cell carcinoma (and no pre-existing ichthyosis uteri), the absence of any high grade dysplastic or koilocytic changes in many segments of the endometrial squamous epithelium argues against this possibility. Bewtra et al [3] recently described a case of endometrial adenocarcinoma covered almost entirely by a plaque-like, keratinizing mature squamous epithelium The latter is in contrast to the plaque-like squamous differentiation which is rarely seen in endometrioid adenocarcinomas of the endometrium [13]; these changes are generally focal or multifocal and are not diffuse as is seen in ichthyosis uteri. A case of squamous cell carcinoma of the cervix with probable proximal extension into, and colonization of, a pre-existing ichthyosis uteri by associated HPV is described. The possibility of significant cervical pathology should be considered when plaques of squamous epithelium with low grade dysplastic changes are identified in an endometrial biopsy or curettage
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