Primary clear cell carcinoma of the cervix: report of five cases and review of the literature

Abstract

To explore the clinical diagnostic and therapeutic characteristics, prognostic factors of patients with primary clear cell carcinoma of the cervix. The clinical, pathologic and follow-up data of patients with primary clear cell carcinoma of the cervix treated in our hospital from Jan 2003 to Dec 2006 were collected and analyzed retrospectively. The relative literature was reviewed. Five patients with primary clear cell carcinoma of the cervix were treated (1 case stage I b1, 2 of stage I b2, 1 of stage IIa, 1 of stage IVa). The mean age was 40.2 years (32 to 50 years). The primary symptom was mostly irregularly vaginal bleeding (3/5) and clinical type was predominantly (4/5) endophytic growth. The positive rate of cervical cytologic examination was 2/4, the negative rate of cervical human papillomavirus (HPV) DNA examination was 4/4. Serum CA125 level was abnormal (62.5 to 592.1 kU/L) before operation and when relapse occurred, and returned to normal after operation. All of five patients underwent operation, pathologic examination showed that three patients with infiltration in deep 1/2 myometrium of cervix, and two patients with infiltration in cervix-corpus juncture. Four patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy. All of four patients underwent four courses of chemotherapy with fluorouracil (5-FU) and carboplatin, one patient (stage II a) was added with intracavitary brachytherapy. None of the four patients had relapse or metastasis after a follow-up of 10 to 44 months. The patient with stage IV a underwent firstly hysterectomy and prerectum mass removal. Pelvic relapse occurred three months after operation and the patient then underwent the second operation, external beam radiotherapy and intracavitary brachytherapy and 8 courses of chemotherapy with paclitaxel (taxol) and carboplatin. There was no relapse or metastasis after a follow-up of 26 months. Primary clear cell carcinoma of the cervix may be unrelated to HPV infection. It shows predominantly endophytic growth and tends toward deep infiltration in cervix and extending to uterine corpus. Operation combined with chemotherapy with carboplatin and 5-FU or taxol may lead to relatively perfect short-term therapeutical effect. Serum CA125 can help to monitor prognosis.