Cervical adenoid basal carcinoma associated with invasive squamous cell carcinoma: A report of rare co-existence and review of literature

Abstract

Cervical adenoid basal carcinoma (ABC) rarely can harbor associated malignancies like adenoid cystic carcinoma or squamous cell carcinoma (SCC), which express markedly different prognosis from a pure ABC, making an appropriate biopsy essential to provide a clear diagnosis and therapeutic plan. We report a 64-year-old asymptomatic lady with an abnormal cervical cytology, who underwent a conization to reveal an ABC with overlying microinvasive SCC. Doubtful resection margins led us to perform radical hysterectomy with lymph node dissection. Subsequent pathological examination showed a true invasive SCC co-existing with ABC, with invasion of the parametrium. Unlike the indolent course of many pure ABC patients, the prognosis of 11 previously reported co-existing invasive SCC with ABC patients appears to depend on the SCC component. Our case reiterates the importance of adequate biopsy with careful interpretation to cover the possibility of a co-existent malignancy. Besides, it presents an argument in favor of radical surgery for the primary treatment of suspicious associated malignancy, and supports adjuvant treatment according to the unfavorable extent of the co-existent invasive carcinoma.

Uncommon Cervical Lesions: A Review and Discussion of the Differential Diagnosis

“…6 The case in question demonstrated anastomosing cords with nuclear atypia that is beyond what is currently accepted for diagnosis of pure adenoid basal carcinoma. These tumors are frequently seen in association with other malignancies such as squamous cell carcinoma, adenoid cystic carcinoma, small cell carcinoma, and carcinosarcoma, and in these cases the prognosis is that of the more aggressive neoplasm, 4,8,9,11,15,16,22 and as such any tumor component with more aggressive histology should be mentioned, and the tumor should be treated on the basis of that component.…”