Squamous cell carcinoma and adenocarcinoma appeared at different cervical sites: a rare case report

Abstract

Background The concurrent development of adenocarcinoma and squamous cell carcinoma in separate regions of the cervix is extremely rare. We report a case of HPV-related adenocarcinoma and squamous cell carcinoma occurring at distinct locations within the cervix in a patient with primary cervical cancer stage IA1. Case presentation A 54-year-old female patient was found to be HPV type 18 positive during a routine physical examination, with Liquid-based Cytology Test (LCT) of the cervix indicating Atypical Squamous Cells of Undetermined Significance (ASCUS). Subsequent colposcopy-directed cervical biopsies identified mid-to-low grade squamous cell carcinoma at several locations (3, 6, 9, 12 o'clock positions and the ECC),and the clinical diagnosis was stage IA1. Preoperative comprehensive abdominal magnetic resonance imaging, including contrast enhancement, did not indicate any lymph node enlargement, and computed tomography urography of the urinary system was unremarkable. The squamous cell carcinoma antigen level was within the normal range. On May 22, 2023, the patient underwent laparoscopic radical resection of cervical cancer under general anesthesia and the postoperative pathology indicated HPV-related squamous cell carcinoma of the cervix (at 11-12 o'clock positions) and HPV-related cervical adenocarcinoma (at 1 o'clock and 3-4 o'clock positions). No cancer invasion was found in the vagina, vaginal margin, or bilateral parametrium. There was no lymphovascular, blood vessel, or nerve invasion. Immunohistochemistry: Adenocarcinoma: Ki-67(90%+), P40(-), P16(diffuse+), MLH1(+), MSH2(+), MSH6(+), PMS2(+), P53(-, mutant type), CK7(+), CEA(+), ER(-), PR(-); Squamous cell carcinoma: P40(partial+), P63(+), ki-67(90%+), CK7(+), P16(diffuse+). Conclusions In this instance, the concurrent manifestation of both squamous cell carcinoma and adenocarcinoma in the cervix, both associated with HPV infection, underscores the likely pivotal role of HPV infection in this unusual phenomenon.Proactive HPV vaccination at an early stage is an effective preventive measure, and regular cervical cancer screenings can aid in the early identification of lesions, leading to improved treatment results.