Introduction This study aimed to evaluate the impact of single and multiple HPV positivity on cervical intraepithelial lesions, specifically focusing on whether the addition of high-risk HPV types to HPV-16 or HPV-18 affects the progression to high-grade lesions. Methods A retrospective analysis was conducted on 612 HPV-positive patients from Karadeniz Technical University Faculty of Medicine, Obstetrics and Gynecology Department (2018-2023) who underwent Pap smear and HPV genotyping. Demographic, cytological, and histopathological data were collected, with HPV types categorized as HPV-16, HPV-18, and other high-risk types. Colposcopic biopsy results were used to assess the risk of cervical intraepithelial neoplasia. Results Among 612 HPV-positive patients, 137 had HPV-16 (17.4%), 39 had HPV-18 (4.9%), and 503 had other high-risk types (63.8%). HPV-16 and multiple high-risk HPV types exhibited a higher proportion of cytological abnormalities. Histopathological analysis showed that the presence of other high-risk HPV types alongside HPV-16 was associated with a lower risk of progression to high-grade lesions compared to HPV-16 alone. Specifically, HPV-16 combined with other high-risk types showed a significantly lower rate of cervical intraepithelial neoplasia. Conclusion The addition of other high-risk HPV types to HPV-16 may slow the progression to high-grade cervical lesions, contradicting the literature that suggests multiple HPV infections increase the risk. These findings contribute to the ongoing debate on the role of multiple HPV types in cervical lesion progression.

Background and Objectives: We aim to examine the histopathological results following hysterectomy performed due to insufficient cervical tissue in patients diagnosed with high-grade squamous intraepithelial lesions (HSILs) who underwent the loop electrosurgical excision procedure (LEEP) and cold-knife conisation (CKC) and exhibited continuity at the surgical margin and residual disease. Materials and Methods: Thirty-four patients who underwent hysterectomy due to insufficient cervical tissue and had HSILs at the surgical margin were included in this study. The following information was analysed: age, body mass index (BMI), parity, menopausal status (premenopausal/postmenopausal), smoking history, smear result, HPV result, colposcopic cervical biopsy result, transformation zone information, LEEP+Endocervical Curettage (ECC) histopathological result, CKC+ECC histopathological result, hysterectomy material histopathological result, presence or absence of cervical glandular involvement, and presence or absence of residual lesions in the hysterectomy material. Results: The mean (±SD) age of the study cohort was 46.7 ± 8.3 years, the mean BMI was 27.4 ± 2.3 kg/m2, and the mean parity was 2.5 ± 0.7. According to the results of the hysterectomy performed on these 34 patients, in whom Cervical Intraepithelial Neoplasia 3 (CIN3) continuity at the surgical margin and the inability to perform re-excision were determined, 8 patients (23.5%) had CIN2, 19 patients (55.9%) had CIN3, 3 patients (8.8%) had adenocarcinoma in situ, and 4 patients (11.8%) had squamous cell carcinoma (SCC). Histopathological examinations of the hysterectomy specimens revealed negative surgical margins in all patients, while glandular involvement was present in 13 patients (34.2%). Conclusions: It should be borne in mind that patients with HSILs showing continuity at the surgical margin may have an underlying squamous cell carcinoma. These patients should be carefully evaluated for hysterectomy if they do not have sufficient cervical tissue for repeat excisional procedures.

Effect of topical photodynamic therapy with 5-aminolevulinic acid in the treatment of high-risk cervical low-grade squamous intraepithelial lesions.

Background/Objectives: Cervical cancer is one of the most frequent malignancies among women in Kazakhstan, where human papillomavirus (HPV) vaccination was initiated in 2024. Despite the implementation of vaccination and cytology-based screening programs, diagnostic limitations remain, and local evidence linking HPV infection to clinical outcomes is scarce. This study aimed to evaluate the correlation between HPV status, cervical cytology results, colposcopic impression, and biopsy results in a non-vaccinated female population. Methods: A cross-sectional study was conducted at the University Medical Center, Astana, between November 2024 and March 2025. A total of 396 women of reproductive age were enrolled. Cervical samples underwent liquid-based cytology and high-risk HPV testing with the RealBest assay. Colposcopy was performed following abnormal cervical cytology results, and colposcopy-guided biopsies were obtained where indicated. Sociodemographic characteristics were assessed, and associations between HPV genotype and clinical outcomes were analyzed using descriptive and inferential statistics. Results: HPV infection was detected in 140 women (35.4%). HPV-16 was the most common genotype (11.4%), followed by HPV-52 (6.6%) and HPV-33 (5.3%). Among 198 women evaluated by colposcopy, abnormal findings were observed in 72.2%, with HPV-16 showing a significant association with higher-grade abnormalities (p < 0.001). Biopsies were available for 40 participants: 12 had CIN I, 12 had CIN II, 10 had CIN III, and 4 had carcinoma in situ. HPV-16 was the only genotype significantly linked to CIN II/III lesions. Conclusions: HPV-16 was strongly associated with abnormal colposcopic findings and high-grade histology, underscoring its oncogenic importance. The prevalence of HPV-52 and HPV-33 further supports the need for HPV nonavalent vaccination. These findings highlight the importance of HPV-based screening, genotype-specific triage, and expanded vaccination to reduce cervical cancer incidence in Kazakhstan.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients who undergo vaginoplasty are at risk of developing HPV-related lesions throughout their life, from low risk condylomata acuminata (CA) to cancerous lesions. However, the HPV status of neovaginal lesion in this patient group were often undocumented. We reported a case of CA, with HPV type 6 and 18 positive, affecting both the neovagina and vulva in a MRKH patient who underwent vaginoplasty (12 months ago). Additionally, we explore the relationship between HPV infection and neovaginal lesions through a review of current literatures. A 21-year-old MRKH patient after vaginoplasty was diagnosed with condylomata acuminata in the neovagina and vulva and was HPV 6 and 18 positive. The colposcopy biopsy of the condylomata acuminata (CA) lesions in the neovagina confirmed a CA lesion, with positive immunohistochemistry (IHC) staining for low-risk HPV (lrHPV). The vulvar lesions were removed by cryoablation with liquid nitrogen, and the neovaginal lesions were treated with carbon dioxide laser ablation. Post-treatment follow up showed complete resolution of neovaginal and vulvar CA, with complete epithelization of the neovaginal lesions. MRKH patients who undergo vaginoplasty are at risk of developing HPV-related lesions throughout their life. This is the first published case of coinfection with both hrHPV and lrHPV, with lrHPV-related CA in an MRKH patient after Sheares' vaginoplasty. Routine HPV screening, HPV vaccination, and condom use should be indicated in this population.

IntroductionFrom 2012 to 2017, the Cervical Cancer Prevention in El Salvador (CAPE) piloted and scaled up a human papillomavirus (HPV) screen-and-treat intervention. Findings resulted in El Salvador’s adoption of the strategy as part of the national programme, but long-term clinical outcomes are unknown. Here, we compare the detection of high-grade cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and HPV infection after recommended screening intervals between two groups: women who participated in CAPE and a comparable group screened via cytology.MethodsCAPE participants who had undergone screening at least 5 years previously (screen-and-treat group) and women in the same age range with conventional cytology screening 2 to 3 years previously (cytology group) were recruited for repeat screening with primary HPV testing. Women with positive HPV results were referred for colposcopy and cervical biopsy to determine further management. Women with negative HPV results received recommendations for routine future screening according to national guidelines.ResultsA total of 6631 women were enrolled (screen-and-treat = 4087; cytology=2544). Significantly less CIN2+ was detected in the screen-and-treat group at 0.7% (29/4087) than in the cytology group at 2.1% (54/2544) (p<0.001) with a risk ratio of 0.41 (95% CI 0.26 to 0.61). HPV positivity was also lower in the screen-and-treat group at 9.5% (388/4077) compared with the cytology group at 11.5% (293/2445) (p=0.008).ConclusionAt the first round of repeat screening after the implementation of CAPE, women who underwent HPV testing in a screen-and-treat strategy had significantly less CIN2+ and HPV positivity compared with those who underwent cytology. These outcomes occurred despite a longer screening interval for HPV testing than cytology. Findings provide reassurance for women and health systems that primary HPV screen-and-treat programmes with extended screening intervals, like the one in El Salvador, are achievable and effective in low- and middle-income settings.

PurposeThis study aimed to retrospectively evaluate the distribution of human papillomavirus (HPV) genotypes, age-specific prevalence, and their association with histopathological outcomes in women with cervical cytology results reported as atypical squamous cells of undetermined significance (ASC-US) and concurrent high-risk HPV (hr-HPV) positivity.Patients and MethodsAmong 39,189 records screened between October 2019 and October 2024, 705 patients with ASC-US and hr-HPV positivity were included. HPV genotyping was performed using real-time PCR, cytological evaluation followed the Bethesda System, and colposcopic biopsies were classified according to the Lower Anogenital Squamous Terminology (LAST) guidelines.ResultsHPV-16 (25.6%), HPV-51 (7%), and HPV-31 (6.5%) were the most prevalent genotypes, detected in 28.2% (n=199) of hr-HPV-positive cases. HPV-16 demonstrated the strongest association with high-grade lesions, accounting for 47.6% of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Multiple HPV infections correlated with an elevated risk of CIN2+. Age-stratified analysis revealed HPV-16 predominance in women aged 40–49 years, whereas HPV-51 was more frequent in those ≥60 years.ConclusionIn ASC-US cases, HPV-16 is the predominant genotype and a significant predictor of high-grade cervical lesions. The unexpectedly high prevalence of HPV-51 and HPV-31 in this Turkish cohort underscores the importance of tailoring screening algorithms to regional genotype distributions. Furthermore, the observed age-specific variations in genotype prevalence highlight the need for age-adjusted management strategies.

Introduction: Cervical cancer is one of the most prevalent cancers amongst women worldwide. Early detection and appropriate management of cervical abnormalities are essential to prevent disease progression and enable timely treatment. This study aimed to compare the diagnostic findings of colposcopy and cervical biopsy in patients with atypical squamous cells of undetermined significance (ASC-US) on Pap smear. Methods: In this descriptive-analytical cross-sectional study, patients with ASC-US Pap smear results who underwent both colposcopy and cervical biopsy between 2019 and 2023 were evaluated. Variables including age, menopausal status, HPV infection, and clinical symptoms were compared across the two diagnostic methods. Result: A total of 400 patients, with a mean age of 37.4 years, were included in the analysis. Most Pap smears were performed before menopause, and high-risk HPV was the most detected type. The most frequent clinical finding was an abnormal cervical appearance. A significant relationship was observed between the type of neoplasia and both age and menopausal status, based on colposcopy and biopsy results. Among women under 50 years of age, 52.5% showed no dysplasia; in those over 50, this rate increased to 87.5%. Cervical intraepithelial neoplasia (CIN) was the most common type of dysplasia across all age groups. Amongst premenopausal women (90.5% of the cohort), 51.6% had no dysplasia and 39.6% had CIN I. In post-menopausal women (9.5%), 97.3% had no dysplasia, with only one case of CIN I. High-risk HPV accounted for 73% of infections, amongst whom 37% showed no dysplasia. Amongst patients with an abnormal cervical appearance (48.9%), 57.1% had no dysplasia and 21.4% had CIN I. Colposcopy demonstrated a sensitivity of 73% and a specificity of 77.64%. Conclusion: In patients with ASC-US Pap smear results, colposcopic findings related to the severity of dysplasia and type of neoplasia were significantly associated with age and menopausal status. However, no significant associations were found with HPV type or clinical symptoms.

ObjectiveTo examine the relationship between cervical dysplasia and tissue levels of nicotinamide phosphoribosyltransferase (NAMPT).Materials and MethodsPatients who underwent colposcopic biopsy due to human papilloma virus positivity were classified as normal tissue and cervical intraepithelial neoplasia (CIN) 1, CIN 2-3. These were stained with NAMPT antibodies using streptavidin-biotin peroxidase method (Invitrogen, 85-9043, CA, USA). The staining intensity was scored as: 0, 1, 2, and 3 for no, mild, moderate, and intense staining, respectively. The percentage score was classified as: 1, 2, and 3 for 1% to 33%, 34% to 66%, and 67% to 100% positivity, respectively. The product score was calculated. Totally, 86 patients were included in the study.ResultsThe NAMPT staining scores were significantly higher in the CIN 2-3 group compared to the group with CIN 1/normal (90% vs 9%; respectively, P < .000). No intense NAMPT staining was observed in any of the specimens with CIN 1 or normal results. The percentage score of 2 to 3 was seen in 83% and 12% for patients with and without CIN 2-3, respectively (P < .000). Using a cutoff value for product score of 2, the test demonstrated a sensitivity, a negative-predictive value, a specificity, and a positive-predictive value of 96%, 98%, 80%, and 71%, respectively. Although the product score was 2 and higher for 96% of CIN 2-3 specimens, 78% of those with CIN 1 or normal results had that below 2.ConclusionThe NAMPT staining differs significantly among groups and may be a useful marker for distinguishing CIN 2-3 from normal tissue and CIN 1. That has potential to improve the sensitivity-specificity of diagnosing and treating cervical premalignant lesions.

Background and aimsCervical cancer remains a significant threat to women’s health, with pregnant women representing a particularly vulnerable population. This study aimed to investigate the impact of cervical intraepithelial neoplasia (CIN) on pregnancy outcomes using longitudinal biological sample analysis.MethodsWe conducted a retrospective study of 125 pregnant women who underwent vaginal examination following abnormal cervical cytology and/or positive human papillomavirus (HPV) testing. Suspected cases underwent colposcopy-directed cervical biopsy performed by experienced clinicians (10 year of work experience) during pregnancy. Postpartum follow-up included repeat cervical cytology, HPV testing, and colposcopic biopsy when indicated.ResultsAmong the 125 patients, 34 underwent colposcopic biopsy during pregnancy, with histopathological results demonstrating strong concordance with colposcopic findings (kappa = 0.82, *p < 0.001). Postpartum follow-up within one year of delivery included colposcopy and cervical biopsy in 98 patients. Multivariate logistic regression analysis revealed that persistent cervical cytological abnormalities (OR 9.838; 95% CI 3.851–25.135; *p < 0.001) were significantly associated with abnormal colposcopic findings.ConclusionFor pregnant women declining cervical biopsy during pregnancy, colposcopy represents a safe and clinically valuable diagnostic tool. Persistent cervical cytological abnormalities, but not HPV positivity, were identified as a significant risk factor for CIN2 + persistence.

The risk of recurrence of high-grade squamous intraepithelial lesions and its association with the number of colposcopic biopsies.

Application of Amniotic Membrane to Effectively Treat Chronic Cervicitis: A Case Series.

Objective: To study the application value and application path of pathological examination in gynecological physical examination. Methods: A total of 1200 patients undergoing gynecological physical examination in X Hospital from January 2024 to December 2024 were selected. All patients received cervical Pap smear examination, and patients with abnormal examination results underwent colposcopic biopsy and HPV infection test for cervical cancer screening. Results: The results of cervical Pap smear showed that a total of 780 patients among 1200 patients showed cervical abnormalities. The Pap smear combined with colposcopy was used for pathological examination to detect cervical cancer lesions in time, and biopsy and HPV infection examination were arranged for high-risk patients to provide data reference for clinical treatment. Conclusions: Pathological examination has a good screening effect in gynecological physical examination. It can detect lesions early and take timely intervention measures, which is helpful to reduce the incidence and mortality of the disease.

Objective: To explore the importance of combined diagnosis (TCT+HPV-DNA) in cervical cancer screening for diagnosis and treatment. Methods: From March 2024 to December 2024, 35 cases were diagnosed as positive by the gold standard (colposcopy biopsy), and then screened by TCT and HPV-DNA typing respectively, and the different results were analyzed. Results: Compared with TCT+HPV-DNA typing, the coincidence rate, specificity and sensitivity of TCT and HPV-DNA typing were significantly lower (P&lt;0.05). Conclusion: Combined diagnosis (i.e. TCT+HPV-DNA typing test) in cervical cancer screening can ensure the accuracy of the results and prompt patients to obtain targeted treatment plans at an early stage.

Aim-To determine the percentage of postcoital bleeding and study the correlation between demographic data, clinical findings, cytology, colposcopy and histopathological reports among women with postcoital bleeding. Materials and Methods: Women ≥18 years of age with postcoital bleeding attending the gynaecology OPD were included in the study. After proper consent, physical and gynaecological examinations were done in 100 patients with postcoital bleeding. Liquid-based cytology was taken from all patients, and colposcopy and cervical biopsy were done when indicated. The percentage of women with postcoital bleeding in this study was 0.115%. The study identified various causes of postcoital bleeding among women, in which 28 cases were linked to inflammation, 17 cases to infections, and 5 cases had unknown causes (idiopathic). Additionally, 25 cases are non-cancerous (benign), 5 cases show early signs of potential cancer (premalignant), and 20 cases involve confirmed cancerous cells, highlighting the diverse reasons behind postcoital bleeding. The study establishes a significant correlation (p = 0.02) between pap smear results and cervical biopsy outcomes in 100 women with postcoital bleeding. A significant correlation (p = 0.002) was observed between colposcopy grading and cervical biopsy results. This study establishes the correlation between cervical biopsy results with final diagnoses, 45 women underwent biopsy, revealing a range of pathologies. Among cases diagnosed with inflammation, chronic inflammation, and focal dysplasia were noted. Benign diagnoses predominantly consisted of polyps, while premalignant cases included one carcinoma in situ. All 19 malignant cases were confirmed as invasive cancer on histopathological examination (HPE), underscoring cervical biopsy's significance as the gold standard for confirming malignancy, supported by a significant p-value of 0.00 at the 95% Confidence Interval. Conclusion- All women experiencing post-coital bleeding should undergo a comprehensive assessment, including pelvic examination followed by a pap smear, colposcopy, and biopsy if necessary. If a cervical smear appears normal in women with post-coital bleeding, it does not necessarily exclude the presence of cervical intraepithelial neoplasia or invasive cancer. Post-coital bleeding should be considered a potentially alarming sign of increased risk for invasive cervical cancer and cervical intraepithelial neoplasia. Timely workup and intervention are recommended.

BackgroundIdentifying high-risk groups for adverse outcomes after conization is crucial for developing targeted treatment plans for patients with cervical adenocarcinoma in situ (ACIS). This study aimed to analyze the clinical characteristics of patients with ACIS and identify risk factors associated with adverse outcomes.MethodsPatients diagnosed with ACIS through colposcopic biopsy at the Affiliated Hospital of Qingdao University and Qilu Hospital between January 2012 and December 2022 were selected. After meeting the inclusion and exclusion criteria, we collected their clinical data. Chi-square (χ2) tests and logistic regression models were employed to determine independent risk factors.ResultsA total of 379 patients with ACIS were included in this analysis. About 26.1% of these patients tested positive on preoperative endocervical curettage (ECC), while 79.4% had a single lesion. Among the 334 patients who underwent cervical conization, 17.1% had positive surgical margins. Additionally, residual lesions were present in 53.6% of cases, and pathological upgrading occurred in 7.8% of patients. Multivariate analysis indicated that age (p < 0.001), preoperative histopathological results from ECC (p = 0.033), and the number of ACIS lesions (p < 0.001) were associated with positive surgical margins. Number of births (p = 0.011), preoperative histopathological results from ECC (p = 0.030), and surgical margin statuses at cervical conization (p < 0.001) were independent risk factors for residual lesions. Preoperative histopathological result of ECC (p = 0.035) was confirmed as a predictor of postoperative pathological upgrading.ConclusionsOlder, multiparous patients with ACIS and abnormal preoperative ECC results require deeper diagnostic excision. Patients with positive conization margins necessitate further treatment, particularly when accompanied by abnormal ECC results. For women who wish to preserve their fertility, a repeat conization may be appropriate; however, in older and multiparous women, a hysterectomy would be recommended.

IntroductionThis study aims to evaluate diagnosis, treatment and clinical outcomes for patients with cervical cancer in pregnancy (CCIP) and their fetuses over a 10-year period, providing clinical evidence for the management of CCIP.MethodsClinical data of 28 patients diagnosed with CCIP at our center between January 1st, 2013 and June 30th, 2023 were retrospectively analyzed, focusing on gestational age at diagnosis, treatment, and maternal-fetal outcomes.ResultsA total of 28 patients with CCIP were identified, accounting for 0.42% (28/6678) of patients with cervical cancer during the study period. The majority of patients (86%, 24/28) had squamous cell carcinoma diagnosed by colposcopic biopsy, and 21 patients presented with recurrent vaginal bleeding. Cervical cancer was diagnosed during pregnancy in 19 cases and in the postpartum period in 9 cases. The mean tumor diameter was 5.4 (2-12) cm. Among 19 patients diagnosed during pregnancy, 13 patients chose pregnancy preservation, resulting in an average delay of treatment by 16.4 (0-33) weeks without observed disease progression. Fetuses were delivered via cesarean section at an average gestational age of 36.3 weeks; eight of these patients received neoadjuvant chemotherapy. At a median follow-up duration of 40.1 (12-103) months, 25 patients survived. Disease-free survival was observed in 20 patients, whereas two patients experienced local progression, and six developed distant metastases.ConclusionClinical outcomes for patients with CCIP appear comparable to those observed in non-pregnant patients in the general population. Pregnant patients presenting with abnormal vaginal bleeding should undergo prompt cervical cancer screening to enable early diagnosis and tailored management strategies. For patients with a strong desire to maintain their pregnancy, careful consideration should be given to postponing delivery until fetal maturity, thereby minimizing maternal and fetal complications and improving maternal and fetal outcomes.

e17528 Background: The goal of this study was to evaluate the utilization and effectiveness of Nurse Practitioners (NPs) in under-resourced areas as a method to enhance access to cervical cancer screening and treatment. Methods: This retrospective study evaluated patients with cervical preinvasive disease on colposcopy referred to a single academic institution for loop electrosurgical excision procedure (LEEP) procedure from January 2022 to December 2024. Patients either received their care at the tertiary care center with a physician or at a state health department with an NP. Self-reported race and primary language data were collected, alongside pathology and lab results from medical records. The primary outcome assessed was the time from abnormal colposcopy to LEEP differences by race and age based on whether they received care at the tertiary care center or a state health department. Data was analyzed using GraphPad. Results: A total of 167 patients underwent LEEP after colposcopy in this study. Of these, 60% (N=100) had their procedure at a single center academic institution, while 40% (N=67) received colposcopy externally by NPs in state health departments. The median age was 33 years (29-40). Most patients were 38% (N=61) Hispanic, 33% (N=52) African American, or 29% (N=46) White Among the cohort, 81 patients (48%) had colposcopic biopsies indicating CIN II, and 69 patients (41%) with CIN III. The remaining 17 patients (11%) had squamous intraepithelial lesions or benign colposcopic results with positive endocervical curettage. The median time from colposcopy to LEEP across all participants was 63 days (22-93). There was no difference in the time to treatment based on age (p=0.42) or race (p=0.48). The duration from colposcopy to LEEP also did not differ significantly based on colposcopy location (p=0.72). This pattern held true across races between locations (p=0.73) and across ages between locations (p=0.16) (Table 1). Conclusions: In conclusion, the time from colposcopy to LEEP remains consistent across healthcare providers, including NPs at local health departments and at a single center academic institution with physicians. With increased utilization of innovative detection methods like the deployment of NPs in state health departments, equal outcomes were noted. The findings further emphasize a critical role that NPs can play in providing necessary care to underserved and rural communities and increasing access to cancer screening care. Time from colposcopy to day of LEEP procedure stratified by demographics. Overall Median Days NPMedian Days Physician Median Days Age &lt;30 64 p= 0.42 58 63 p=0.16 30-39 63 72 63 &gt;40 70 72 61 Race White 63 p=0.48 72 63 p=0.73 African American 65 72 63 Hispanic 63 71 63 Colposcopy Location External 68.5 p=0.72 SCAI 61

Comparison of efficacy of ALA-PDT and CO2 laser in the treatment of vaginal intraepithelial neoplasia II (VaIN II).

Rationale:The incidence of cervical adenocarcinoma is increasing, particularly in women of reproductive age, and presents a unique diagnostic and therapeutic challenge when encountered during pregnancy. Distinguishing malignant cervical lesions from benign entities such as nabothian cysts can be particularly difficult due to overlapping clinical and imaging features, leading to potential delays in diagnosis and management.Patient concerns:A 38-year-old multiparous woman at 7 weeks’ gestation was referred to a tertiary hospital for an abnormal Papanicolaou smear showing atypical glandular cells of undetermined significance and positive for high-risk human papillomavirus (HPV) type 18 infection. She was asymptomatic, with no vaginal bleeding, pelvic discomfort or other suggestive symptoms.Diagnoses:Initial imaging and colposcopic findings suggested a nabothian cyst. However, 4 weeks later, atypical cytological findings and HPV 18 positivity prompted further surveillance. At 26 weeks’ gestation, cervical biopsy confirmed moderately differentiated HPV-associated cervical adenocarcinoma. Magnetic resonance imaging staged the disease as International Federation of Gynecology and Obstetrics stage IB1.Interventions:After multidisciplinary consultation, the patient underwent classical cesarean section followed by type 3 radical hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy and ovarian transposition at 29 weeks 6 days gestation. Magnesium sulfate and corticosteroids were administered for fetal neuroprotection and lung maturation.Outcomes:Pathology confirmed a 1.5 cm cervical adenocarcinoma without lymphovascular space invasion, parametrial extension or lymph node metastasis. The patient has remained disease-free for 4 years under regular oncological surveillance.Lessons:This case highlights the diagnostic complexity of cervical adenocarcinoma in pregnancy, particularly when lesions mimic benign cervical pathology. Persistent atypical cytology and high-risk HPV positivity warrant thorough evaluation, including colposcopic biopsy, despite pregnancy. A multidisciplinary approach is essential for optimal maternal and fetal outcomes.