Papillary squamotransitional cell carcinoma of the uterine cervix: a case report and review of the literature

Abstract

BackgroundPapillary squamotransitional cell carcinoma of the uterine cervix is a rare neoplasm, a subtype of transitional cervical carcinoma that appears to be a variation of squamous cervical carcinoma. It has a disposition toward metastasis at an advanced stage and local recurrence. Owing to the difficulty of illustrating the invasion histologically, misdiagnosis is likely to affect the patient’s prognosis.Case presentationWe present a case report of an 81-year-old Caucasian patient with squamotransitional cell carcinoma with unusual clinical behavior that was primarily thought to be ovarian cancer. According to the clinical examination and radiologic imaging, the patient had no vaginal bleeding and a normal cervix. Nevertheless, the tumor was already metastasized at the retroperitoneal tissue and at the right ovary. Computed tomography-guided biopsy of the right adnexa gave no further clarification. Although the tumor resembled urothelial cancer, this diagnosis was dismissed because of the results of immunohistochemistry analysis with CK7+, CK5+, and CK20−. Because of the differential diagnosis of ovarian cancer, we decided in favor of an exploratory surgical approach. Hysterectomy with bilateral adnexectomy, extensive retroperitoneal tumor debulking, and infragastric omentectomy was performed by laparotomy. Histopathology revealed a squamotransitional cervical cancer as the primary tumor with a tumor stage of pT3b, pN1 (1/2), V0, RX, G2, corresponding to International Federation of Gynecology and Obstetrics stage IIIB.ConclusionsAs far as we are aware, this is the first report of papillary squamotransitional cell carcinoma of the uterine cervix metastatic to the ovary without vaginal bleeding and with a clinically and radiologically unsuspicious cervix. Physicians should always contemplate papillary squamotransitional cell carcinoma of the uterine cervix in unclear cases with ovarian metastasis, especially if the histology indicates a transitional cancer (CK7+ and CK20−), before proceeding with treatment. More cases are needed to illuminate the clinical characteristics and categorization of papillary squamotransitional cell carcinoma of the uterine cervix.

Impaired inflammatory state of the endometrium: a multifaceted approach to endometrial inflammation. Current insights and future directions

“…Very importantly, gynecological malignancies, mainly cervical and endometrial ones, have also been demonstrated to be related to chronic inflammation, be it mediated by infectious or non-infectious conditions [17,69,70,123]. This highlights the long-term importance of proper diagnosis and management of chronic inflammation.…”

A study of histomorphology and immunohistochemistry of papillary squamotransitional cell carcinoma: A rare variant of squamous cell carcinoma of cervix.

“…10,11 It shows aggressive biological behavior and needs close and extended follow up after definitive treatment as it tends to recur locally and can have late metastasis. [12][13][14][15] We herein present a study of detailed histomorphology along with immunohistochemistry (IHC) correlation of 18 cases of PSTCC diagnosed in our institution.…”

“…5,9 They were poorly characterized in the literature and it remained unclear for a long time whether these tumors represented a different group of tumors or were within a spectrum of clinically homogenous and morphologically similar entities. 15,17 Marsh, in the year 1952 initially identified these lesions when 3 out of 31 papillary tumors of the cervix turned out to be malignant. Later in 1958, Kazal observed that 2 out of 20 cases reported as squamous cell papillomas of the cervix showed transformation to SCC.…”

Papillary squamotransitional cell carcinoma of uterine cervix: A case report

“…Al-Nafussi and Al -Yusif, in their study, concluded that papillary SCC has a propensity for late metastasis and local recurrence even though histologically it could be misinterpreted as CIN3 with a papillary configuration or as a squamous papilloma [3] . In the literature, the clinical behavior of PSTCC is characterized as almost the same as that of SCC, except for the tendency of PSTCC towards the metastasis and local recurrence [2] . Cervical transitional (SCC) cells have different staining patterns (CK7+/CK20-).…”

“…PSTCC can be described as an "in situ" tumour with or without an invasive part but usually with both components existing. Furthermore, it is difficult to distinguish PSTCC from other papillary lesions of the cervix because of its papillary exophytic nature [2] . Hence it becomes necessary to separately identify from the commoner and benign varieties of the cervical papillary lesions like condyloma accuminata and squamous papillomas because of potentially aggressive biological course.…”