Korean J Obstet Gynecol.  2011 Oct;54(10):634-638. 10.5468/KJOG.2011.54.10.634.

A case of squamous cell carcinoma of the uterine cervix with diffuse hematogenous lung metastasis in a 36-year-old virgin

• Shim AR
• Choi EK
• Yun SH
• Lee M
• Lee MK
• Kim SW

• KMID: 1836752
• DOI: http://doi.org/10.5468/KJOG.2011.54.10.634

Abstract

The carcinoma of the uterine cervix in virgins is extremely rare. A 36-year-old virgin presented with a 4.8 x 2.2 cm sized endocervical mass with bleeding on sonography. Biopsy revealed a squamous cell carcinoma arising in the uterine cervix without human papilloma virus (HPV) DNA. Positron emission tomography revealed cervical cancer with multiple hematogenous lung metastases. After 3 cycles of preoperative chemotherapy, she underwent modified radical hysterectomy and 6 cycles of postoperative chemotherapy. After the treatment, complete resolution was obtained, and she has been followed without recurrence for 4 years. Although > 90% of cervical cancer is caused by HPV infection, we cannot completely deny the possibility of HPV negative cervical carcinoma.

Keyword

Squamous cell carcinoma; Virgin; Human papilloma virus DNA negative

MeSH Terms

Adult
Biopsy
Carcinoma, Squamous Cell
Cervix Uteri
DNA
Female
Hemorrhage
Humans
Hysterectomy
Lung
Neoplasm Metastasis
Papilloma
Positron-Emission Tomography
Recurrence
Uterine Cervical Neoplasms
Viruses
DNA

Figure

• 

  Fig. 1 Magnetic resonance imaging demonstrated a 4.8 × 2.2 cm sized mass and it was suspected to be endometrial carcinoma.

• 

  Fig. 2 Positron emission tomography scan revealed cancer mass confined to the uterine cavity with multiple hematogenous lung metastases.

• 

  Fig. 3 Gross findings.

• 

  Fig. 4 (A) Most tumor cells show squamous cell carcinoma, large cell non-keratinizing (H&E, × 200). (B) Positive immunoreactivities for P53 (Immunohistochemistry, × 200).

Reference

1. Bosch FX, de Sanjosé S. The epidemiology of human papillomavirus infection and cervical cancer. Dis Markers. 2007. 23:213–227.

2. Bosch FX, Manos MM, Muñoz N, Sherman M, Jansen AM, Peto J, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995. 87:796–802.

3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999. 189:12–19.

4. Wang IT, Chang CW, Tang WL, Chen WY, Liu WM. Keratinizing squamous cell carcinoma of the cervix in a sexually inexperienced woman: a case report. J Reprod Med. 2006. 51:745–746.

5. Bielecki A, Borowicz K, Misiewicz L. Adenocarcinoma of the cervix uteri in a 37-year-old virgin with coexisting cancer of the body of the uterus. Am J Obstet Gynecol. 1963. 87:135–136.

6. Schwarz E, Freese UK, Gissmann L, Mayer W, Roggenbuck B, Stremlau A, et al. Structure and transcription of human papillomavirus sequences in cervical carcinoma cells. Nature. 1985. 314:111–114.

7. Narisawa-Saito M, Kiyono T. Basic mechanisms of high-risk human papillomavirus-induced carcinogenesis: roles of E6 and E7 proteins. Cancer Sci. 2007. 98:1505–1511.

8. Wise-Draper TM, Wells SI. Papillomavirus E6 and E7 proteins and their cellular targets. Front Biosci. 2008. 13:1003–1017.

9. Burger MP, Hollema H, Pieters WJ, Schröder FP, Quint WG. Epidemiological evidence of cervical intraepithelial neoplasia without the presence of human papillomavirus. Br J Cancer. 1996. 73:831–836.

10. Park DJ, Wilczynski SP, Paquette RL, Miller CW, Koeffler HP. p53 mutations in HPV-negative cervical carcinoma. Oncogene. 1994. 9:205–210.

11. Min-min H, Ming-rong X, Ze-yi C, Kai-xuan Y, Zhi-lin S. Analysis of p53 codon 72 polymorphism and its association with human papillomavirus 16 and 18 E6 in Chinese cervical lesions. Int J Gynecol Cancer. 2006. 16:2004–2008.

12. Belhocine T, Kridelka F, Thille A, De Barsy C, Foidart-Willems J, Hustinx R, et al. Staging of primary cervical cancers: the role of nuclear medicine. Crit Rev Oncol Hematol. 2003. 46:275–284.

13. Lindstrom AK, Stendahl U, Tot T, Lidström BM, Hellberg D. Predicting the outcome of squamous cell carcinoma of the uterine cervix using combinations of individual tumor marker expressions. Anticancer Res. 2007. 27:1609–1615.

14. Braun K, Ehemann V, Waldeck W, Pipkorn R, Corban-Wilhelm H, Jenne J, et al. HPV18 E6 and E7 genes affect cell cycle, pRB and p53 of cervical tumor cells and represent prominent candidates for intervention by use peptide nucleic acids (PNAs). Cancer Lett. 2004. 209:37–49.

15. Nair S, Pillai MR. Human papillomavirus and disease mechanisms: relevance to oral and cervical cancers. Oral Dis. 2005. 11:350–359.