Squamous cell carcinoma covering the cervical fibroma

A 62-year-old woman, G4P3, presented to the hospital with vaginal discharge and intermittent spotting for 6 months. She was identified with an asymptomatic vaginal mass 10 years ago, but missed cervical cancer screening and further evaluation. Her pelvic examination showed a large vaginal mass of 6 cm originating from the cervix with an ulcerative lesion of 4.5 × 3.5 cm. The mass was mobile with clear edges, and the vagina and parameter were not involved on palpation. Magnetic resonance imaging showed a normal uterus and a fibroid protruding into the vagina with a slightly elevated signal intensity lesion on its surface (Figure 1) without pelvic lymphadenopathy. A gross biopsy of the lesion revealed a squamous cell carcinoma. The patient was clinically diagnosed with stage IB2 cervical cancer (FIGO 2009) covering a large cervical fibroid and underwent radical hysterectomy (Figure 2) with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Histopathology identified (1) a squamous cell carcinoma developing from the cervical transformation zone (Figure 3) without involvement of the eutopic cervix, (2) an invasion of superficial stroma not involving the cervical fibroma, (3) none invasion of the lymphovascular space, (4) no impairment of the parameter or the lymph node, resulting in a T1BN0M0 stage (IB2, FIGO 2009). The patient recovered without incident. She received no radiotherapy or chemotherapy and had no recurrence at follow-up 3 years later.

Figure 1Magnetic resonance image. Arrowhead, uterus; *, a vaginal mass with low signal intensity; arrow, a slightly elevated signal intensity lesion on the mass.

Figure 2:

Figure 2Raw view of the specimen. Arrowhead, uterus; *, cervical leiomyoma; arrow, cervical cancer.

Figure 3:

figure 3The pathology showed a squamous cell carcinoma. Magnification: 100 ×.

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