Obstet Gynecol Sci.  2019 Nov;62(6):483-486. 10.5468/ogs.2019.62.6.483.

A case of extremely early cervical adenocarcinoma diagnosed only by endocervical curettage with macroscopic pelvic lymph node metastases

• Jung JH
• Kim BR

• KMID: 2462129
• DOI: http://doi.org/10.5468/ogs.2019.62.6.483

Abstract

Microinvasive adenocarcinoma is not as well studied as microinvasive squamous cell carcinoma because diagnosis of adenocarcinoma cannot be ascertained for early invasive lesions. However, most clinicians consider a depth of invasion of 3 mm without lympho-vascular space invasion as the maximum limit for conservative management. Microinvasive cervical adenocarcinoma is characterized by a rare incidence of lymph node metastasis and very good prognosis. We describe a 62-year-old patient with an extremely early cervical adenocarcinoma which was detected only by endocervical curettage. However, she had multiple macroscopic pelvic node metastases. Clinicians should consider the probability of lymph node metastasis, although management of stage IA1 cervical adenocarcinoma may still be conservative.

Keyword

Cervical cancer; Microinvasive adenocarcinoma; Lymph node metastasis

MeSH Terms

Adenocarcinoma*
Carcinoma, Squamous Cell
Curettage*
Diagnosis
Humans
Incidence
Lymph Nodes*
Middle Aged
Neoplasm Metastasis*
Prognosis
Uterine Cervical Neoplasms

Figure

• 

  Fig. 1 (A) Colposcopy shows unsatisfactory findings. (B) Pelvic magnetic resonance imaging (MRI) reveals multiple enlarged lymph nodes in the right external iliac nodal station, which show restricted diffusion in a diffusion-weighted image (white arrow). (C) Pelvic MRI shows heterogeneous enhancement on a T1-weighted contrast enhanced image (black arrow). (D) Positron emission tomography-computed tomography (PET-CT) reveals intense hypermetabolism on the right external iliac nodal station (red arrow) and internal iliac nodal station (blue arrow). (E) PET-CT reveals no hypermetabolic lesion on the uterine endocervix.

• 

  Fig. 2 (A) A photomicrograph shows many scattered fragments of adenocarcinoma in the curettage specimen (black arrow) (hematoxylin and eosin [H&E], 40×). (B) A photomicrograph shows atypical cribriform glands with frequent mitotic figures (red arrow) (H&E, 400×). (C) A photomicrograph shows many clusters of metastatic adenocarcinoma in the pelvic lymph nodes (white arrow) (H&E, 40×).

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