Serous Carcinoma of the Uterine Cervix, an Extremely Rare Aggressive Entity: A Literature Review

Abstract

Background/Aims: Serous carcinoma of the uterine cervix (USCC) is an extremely rare subtype. To establish the treatment strategy in patients with USCC is an important issue. Methods: MEDLINE (PubMed) was searched for all articles published after the first publication by Lurie et al. [Eur J Obstet Gynecol Reprod Biol 1991; 40: 79–81], reporting woman diagnosed with USCC. Because of limited numbers of studies on the topic of the study, we could not keep a restriction of eliminating smaller sample sizes. Results: A search of PubMed demonstrated that 113 cases of USCC have been reported in the literature since the first publication. The current treatment modality adopted for early cervical cancer is hysterectomy with bilateral iliac-obturator lymphadenectomy and postoperative radiotherapy (RT) or radiochemotherapy (RT-CT) if risk factors for cervical carcinoma appear. The treatment strategy for locally advanced USCC is preoperative RT-CT or chemotherapy (CHTH) with the intention to treat the patient surgically. The treatment option for disseminated disease is CHTH with paclitaxel and carboplatin. Conclusion: Risk factors and a more advanced clinical stage of USCC have an impact on poor outcomes despite the use of standard treatment methods, adapted for cervical cancer. The outside-pelvic failures tend to seek effective systemic treatment.

The association between expression of p53 and aggressiveness of serous adenocarcinoma of the uterine cervix

“…Other studies have reported high-risk HPV DNA in 0%–75% of cases. [ 6 17 18 19 ] In the present study, two (29%) cases were of positive HPV DNA (type 18), which supports a weak association with SACC development. Further studies are needed to investigate the association between HPV infection and the occurrence of SACC.…”

“…described the molecular features of SACC, and concluded that it is usually positive for p16, carcinoembryonic antigen (CEA), CA-125, or p53 and negative for WT-1, estrogen, progesterone, PAS, or vimentin. In previous reports, percentage p53 immunopositivity ranged from 42% to 90%[ 5 6 13 ] and p53 expression was associated with poorer clinical outcomes. [ 5 8 11 14 ] These reports indicate that strong p53 expression is associated with recurrence, metastases, and death, and that assessment of p53 status might be prognostically meaningful.…”

“…first detailed the clinicopathological features of SACC. [ 5 6 ] Ages of the 17 patients varied widely (from 27 to 79 years). Interestingly, a bimodal distribution was observed; one peak occurred before the age of 40 years (premenopausally) and the other after the age of 65 years (postmenopausally).…”

“…In our patients, the main clinical symptoms of SACC were abnormal vaginal bleeding; watery vaginal discharge; and polypoid, exophytic, or ulcerated cervical mass by pelvic examination, which concurs with previous reports. [ 6 7 ]…”

“…Patients with early-stage SACC and no risk factors appear to have a favorable prognosis after radical hysterectomy alone. [ 6 ] The biological behavior of early-stage SACC seems similar to that of common-type adenocarcinoma of the uterine cervix. However, advanced-stage SACC is likely to recur, and its behavior is more aggressive.…”