EP33.17: Prolapsed submucous myoma with incidental finding of endocervical adenocarcinoma

Abstract

A 31 y.o. nulligravid, with vaginal bleeding and hypogastric pain for 17 days. Treated as abnormal uterine bleeding due to prolapsed submucous myoma and pelvic inflammatory disease. Pap smear negative for premalignant lesions and HPV DNA test negative, with 6 x 5 cm firm mass at the internal cervical os, uterus 14 week size with bilateral adnexal tenderness. TVS showed enlarged uterus, 9.30 x 7.47 x 9.59 cm, dilated endometrial cavity with fluid of low level echoes, three intramural myomas as with subserous 3.58 x 3.28 x 3.68 cm; 4.74 x 2.71 x 4.10 cm and 1.70 x 1.18 x 1.41 cm. Enlarged cervix 5.61 x 4.05 x 5.95 cm heterogeneous mass 4.03 x 0.99 x 2.60 cm, colour score = 3, moderate flow. Endometrial thickness is 8 mm, with sub mucous myoma 2.67 x 2.63 x 1.44 cm. Right adnexa has irregular mass 8.00 x 3.37 x 7.88 cm or tubo-ovarian abscess. Treated by a gynecologic-oncologist, given 2 doses of Leupron injection 3.75 mg/IM and treated for PID, readmitted with the same TVS findings. Patient underwent hysteroscopic resection of the endocervical myoma and endometrial curettage. Histopathology result was cervical and endometrial adenocarcinoma. Immunochemical stains were negative for P16, ER, PR and positive for CK20, CDX2, CEA and CK 7 (focal). Immunomorphologic findings compatible with colon primary. In the USA, cervical cone biopsy done, colonoscopy and endoscopy, CT with contrast and PET scan are negative for primary colon. Diagnosed as endocervical cancer stage 2B and is for chemotherapy, radiation and brachytherapy. Incidence cervical adenocarcinoma is more common than squamous cell carcinoma. Human papillomavirus (HPV) is a primary cause. The average age is 45-55 years old, but can be seen in younger women. The symptom is abnormal vaginal bleeding. Diagnosis is based on cervical biopsy. According to FIGO clinical staging is based on pelvic exam, cystoscopy, and rectoscopy. Pelvic ultrasound with Doppler studies, MRI and PET scan can be used for evaluation of cervical cancer for optimal treatment. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.