A young woman with clear cell adenocarcinoma of the uterine cervix

Abstract

In May 1999, an 18-year-old woman visited a physician because of vaginal bleeding and the excretion of large clots from the vagina. A vaginal tumor was discovered and the patient was referred to our outpatient department. Vaginal examination showed a bleeding, tumor, approximately 6 cm in size, protruding from the cervical os and filling the vagina. The cytological finding of the uterine cervix was class V, and the histological diagnosis by punch biopsy was clear cell adenocarcinoma (CCAC) of the uterine cervix. The patient initially received neoadjuvant chemotherapy (NAC) with intraarterial injections of 8 mg/m(2) of mitomycin, 270 mg/m(2) of etoposide, and 380 mg/m(2) of carboplatin. Although the NAC reduced the size of the tumor, it failed to produce favorable pathological changes and was therefore deemed ineffective. A radical abdominal hysterectomy and pelvic lymphadenectomy were performed on October 12. Macroscopic findings showed a tumor, 6 cm in diameter, growing from the right side of the uterine cervix, with a fragile, necrotic surface. Pathological diagnosis was CCAC of the cervix (pT2a, N0, M0). The patient was discharged from our hospital without any postoperative chemotherapy or radiation therapy. No signs of recurrence have been detected since. We reviewed the literature on CCAC patients in Japan up to the present and compared the data with the data reported in a review of CCAC in the Netherlands. While there were similarities between the patients in the two countries in the patients' pattern of growth and the poor prognosis of the tumors, there was a significant difference between the countries in the patients' history of diethylstilbestrol (DES) exposure. These results suggest that menarche and menopause may play roles in promoting carcinogenesis, or alternatively, that a subpopulation of women are subject to genetic or exogenous risk factors other than DES.

Clear-cell adenocarcinoma of the uterine cervix in a 17-year-old adolescent

“…13 In this article, we have described the case of the youngest Japanese person to be diagnosed with CCAC of the uterine cervix, among the reported cases in the literature.…”

Characteristic Cytological Features of Cervical Clear Cell Adenocarcinoma: A Report of 4 Cases

“…There have been numerous reports describing the clinicopathological variables and prognosis of cervical CCAC. Some studies have reported that the prognosis of CCAC patients is similar to that of patients with squamous cell carcinoma [6]; however, other reports have shown that CCAC prognosis is poorer than that of other types of cervical cancers due to recurrence of cervical CCAC following chemotherapy and radiation [9]. To help achieve better prognoses in cervical CCAC, earlier diagnosis will be necessary.…”

Letter to the Editor Clear cell adenocarcinoma of the uterine cervix in a 24-year-old woman. and review of the literature

“…The only risk factor present in our patient, but typical for this age group in the population, was the history of oral contraceptive use, which was suggested by some authors to increase the incidence of cervical adenocarcinoma, especially in the group of recent and current users [4,5]. The only presented clinical manifestations of the pathological transformation on the uterine cervix in our patient were abnormal vaginal bleeding, according to many authors the most common symptom of cervical adenocarcinoma, and the presence of cervical erosion [6,8].…”

“…Survival of patients with cervical adenocarcinoma was recently reported in five randomized phase III trials to be improved when combination of postoperative radiation and platinum-based chemotherapy is applied [4,8,14,15], while one trial examining this regimen demonstrated no benefit [16]. The mode of treatment depends in most cases on the experience of the oncology center.…”

“…The mode of treatment depends on patient factors and available local experience. The size of the primary tumor is an important prognostic factor and should be carefully evaluated in choosing optimal therapy [2,8]. For adenocarcinomas that expand the cervix greater than 3 cm, the primary treatment should be radiaLeszek Gottwald, Jerzy Korczyński, Ewa Góra, Renata Kusińska, Ewa Rogowska, Katarzyna Wójcik-Krowiranda, Andrzej Bieńkiewicz tion therapy.…”