Cystic Fibrosis Involving the Cervix, Mimicking a Well-differentiated Adenocarcinoma

Abstract

We describe clinicopathologic and immunohistochemical features of an unusual case of cystic fibrosis manifesting in the cervix as a mass lesion, mimicking cervical adenocarcinoma. A 24-year-old nulligravida with cystic fibrosis developed heavy postcoital vaginal bleeding 4 months after starting oral contraceptives and was found to have a cervical mass. She underwent a loop electrosurgical excision of the mass, and microscopic examination revealed a florid endocervical proliferation, extending to the margins. This lesion was initially interpreted as an invasive, well-differentiated endocervical adenocarcinoma. However, on subsequent review, the lesion was found to have a low rate of proliferation, no evidence of an infiltrative growth pattern, and abundant acute inflammation. Given these findings and the absence of any residual endocervical lesion on a subsequent cold knife conization, we determined that this was a benign, likely reactive, lesion. This case, together with previous studies, suggests that women with cystic fibrosis can develop proliferative endocervical lesions and that oral contraceptives may contribute to their development.

Estrogen and progesterone differentially regulate the levels of cystic fibrosis transmembrane regulator (CFTR), adenylate cyclase (AC), and cyclic adenosine mono‐phosphate (cAMP) in the rat cervix

“…The role of HCO 3 − in reducing the viscoelasticity of cervical mucus is consistent with the effect that sodium bicarbonate (NaHCO 3 ) douching has on improving sperm penetration in post‐coital tests (Everhardt et al, ). In the absence of HCO 3 − , as in patients with cystic fibrosis, mucus adheres to the crypt walls of the cervical lumen (Curlin and Bursac, ), which could block sperm penetration (Previs et al, ). As shown in our study, down‐regulation of Cftr protein and mRNA by progesterone might reduce HCO 3 − secretion, preventing mucin from expanding as well as halting the formation of sperm‐transportable mucus.…”

Contraception in women with cystic fibrosis: a systematic review of the literature

“…More recent case reports have noted other possible complications of hormonal contraception in women with CF. One describes a patient who developed a 3-cm benign, mucinous cervical mass 4 months after initiating a progestin-only pill [13]. Another reports that a woman with CF and a patent foramen ovale developed a transient ischemic attack 2 months after starting the combined oral contraceptive pill [14].…”