Superficial spreading cervical squamous cell carcinoma in situ involving the endometrium: a case report and review of the literature

Abstract

Background The spread of cervical squamous cell carcinoma to the inner surface of the uterus with replacement of the endometrium is rare. Continuity of the lesion must be demonstrated to confirm superficial spread and rule out concomitant endometrial cancer. Case presentation We present the case of a 66-year-old white woman with superficial spreading squamous cell carcinoma of the cervix that involved the endometrium. Her relevant past history included conization of the cervix to treat cervical intraepithelial neoplasia III with positive margins. She subsequently had three negative cervical vaginal cytology results, each with a positive high-risk human papillomavirus test. Transvaginal ultrasound showed occupation of the entire uterine cavity by dense material consistent with pyometra in addition to myometrial thinning due to tension and cervical dilation. The patient presented with greenish vaginal discharge of 3 months’ duration. The cervix was not visible during speculum examination. Access for endometrial sampling was not possible, raising suspicion of post-conization cervical stenosis. The patient was treated with laparoscopic hysterectomy with double adnexectomy. Histologic examination showed superficial squamous cell carcinoma invading the cervix to a depth of 2.8 mm; superficial spreading squamous cell carcinoma in situ was also observed in the lower uterine segment and endometrium. The patient was free of symptoms 12 months after surgery. Conclusions Squamous cell carcinoma of the cervix with superficial spread to the endometrium is not included in the 2020 (fifth edition) World Health Organization Classification of Female Genital Tract Tumors or the 2018 International Federation of Gynecology and Obstetrics cervical cancer staging system. More clinical cases are needed to identify other prognostic factors and inform clinical practice guidelines on the management of this disease.

Exploring the Pathological Journey of Superficial Spreading Squamous Cell Carcinoma of the Cervix Into the Endometrium

“…Cervical stenosis was found to be one of the risk factors for superficial spreading SCC of the cervix into the endometrium in many studies [ 4 , 5 ], but in the present case, we could not find any stenosis. There are two possible theories for the superficial spread of cervical carcinoma.…”

Endometrial squamous cell carcinoma originating from the cervix: A case report

“…Astonishingly, we have found that some cases even shared the same characteristics as ours, for example, in a very recent case published in Spain, the 66-year-old patient also underwent cervical conization 15 years ago and had a finding of HSIL, was lost to regular follow-up, and underwent laparoscopic hysterectomy for the symptoms of vaginal discharge after discovering cervical stenosis and pyometra. Her final pathology also revealed HSIL within the cervix and SCC in the endometrium with a depth of 2.8 mm[ 7 ]. Anne Chao et al [ 8 ] also reported a case with fatal pyometra (1200 mL of pus that was cultured Staphylococcus epidermidis) in a 60-year-old patient whose pathology also revealed cervical HSIL that progressed into SCC in the endometrium.…”

Morphological and Some Immunohistochemical Features of Different Histotypes of Uterine Body Cancer

“…Плоскоклеточный рак эндометрия также регистрируется в пределах 1%, однако отдельным морфотипом данная опухоль не выделена ни в одной из существующих классификаций. Тем не менее, интерес к этому гистотипу эндометриоидной аденокарциномы в последние годы растет и привлекает все большее внимание как зарубежных, так и отечественных исследователей из-за своей агрессивности и высокого опухолевого потенциала [6][7][8].…”