Difficult Diagnosis of Minimal-deviation Adenocarcinoma of the Uterine Cervix: a Case Report and Review of the Literature.

Abstract

Background: Minimal-deviation adenocarcinoma (MDA) is a rare form of cervical adenocarcinoma. The clinical manifestations of MDA were not typical. Cervical cancer screening is not always effective at screening for MDA. Early clinical manifestations of MDA were lack of specificity and frequently regarded as cervicitis, the effect of treatment was usually poor. The cytological characteristics of MDA were similar to the normal cervical endometrial glands. It was difficult to distinguish between MDA and benign endometrial lesions. Therefore, early diagnosis difficulties often lead to delayed diagnosis.Case presentation: A rare case of MDA of the uterine cervix undergoing a hard process to make a confirmed diagnosis is reported. This case, with an initial complaint of cervical contact bleeding, pelvic pain, and vaginal itching, was negative for Thinprep cytologic test (TCT), the human papillomavirus (HPV) genotyping test by Hybrid Capture 2 (HC2), and cervical biopsies. Finally, the MDA was diagnosed with the assistance of the Bard-Magnum Biopsy Instrument under computed tomographic (CT) guidance and staged as an IIIB tumor according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system. The patient received concurrent chemoradiation as primary treatment and unfortunately died a few months later.Conclusion: Thus, MDA should be considered in the differential diagnosis of a cervical space-occupying lesion with negative HPV, cervical cytology, and biopsy. With the assistance of the Bard-Magnum Biopsy Instrument, CT-guided biopsy of deep cervical tissues could improve the early diagnosis rate of MDA, which was helpful for clinicians in early diagnosis.