Papillary squamous cell carcinoma of the cervix: Two cases and a review of the literature

Abstract

ObjectivePapillary squamous cell carcinoma of the cervix (PSCC) is a rare and distinct form of cervical carcinoma. Detecting stromal invasion on biopsy is difficult due to the papillary growth of the tumor. Here we present two cases that highlight the diagnostic and clinical challenges of PSCC.Case 1A 50-year-old woman found to have carcinoma on a routine pap-smear. The patient was diagnosed with PSCC on colposcopic biopsy and underwent a radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection. Her final pathology demonstrated PSCC with no evidence of stromal invasion. At her 3-month follow up visit, she was noted to have a tumor recurrence at the vaginal cuff, again with no stromal invasion. She is currently undergoing definitive radiation therapy with sensitizing cisplatin.Case 2An 82-year-old woman presented with post-menopausal bleeding and was found to have an exophytic mass. Biopsies were taken and showed PSCC with no stromal invasion identified. She underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Final pathology indicated no invasion. She is currently being followed for persistent vaginal dysplasia.ConclusionPSCC is a rare tumor that has previously been described as less aggressive than classical squamous cell carcinoma. These two cases demonstrate the complex behavior of the disease. Case 1 highlights that PSCC may recur even when stromal invasion cannot be confirmed pathologically.

Papillary squamotransitional cell carcinoma of uterine cervix: A case report

“…In conclusion, PSTCC has been reported to represent 1.6% of all cancer cervix [5] . It is a very distinct histologic variant associated with an aggressive biological behavior.…”

“…Original data suggested that PSCC behaves clinically like traditional squamous cell carcinoma. Recently the disease has been suggested to be less aggressive than typical SCC [5] . Koenig et al Studied 32 cases of PSTCC cervix.…”

“…Invasion can appear as nests at the base of the lesion, and in some cases the actual papillae may invade. PSCC lesions without stromal invasion should be treated clinically as cancer according to the corresponding critical stage [5] . The differential diagnosis includes CIN3 with papillary configuration, condyloma, squamous papilloma; or transitional cell carcinoma, endometroid adenocarcinoma, papillary serous carcinoma and well-differentiate villoglandular (papillary) adenocarcinoma.…”

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

“…8 However, due to its distinct clinical behavior it should be distinguished from other TCC and other papillary lesions of the cervix, including condyloma, squamous papilloma, verrucous carcinoma, and cervical intraepithelial neoplasia grade 3 with papillary configuration. [9][10][11][12] PSTCC grossly has a distinguishing surface papillary growth pattern and can be deeply invading. Histologically, it is characterized by sheets of atypical basaloid cells, often non-keratinizing, showing moderate to severe nuclear atypia, and supported by fibrovascular cores.…”

Diagnosis and treatment of cervical papillary squamous cell carcinoma with unknown depth of stromal invasion

“…Cervical PSCC is considered to be less aggressive than classic squamous cell carcinoma. However, some case reports have demonstrated the complex behavior of the disease. As a result, the pathologic examination of colposcopy‐guided biopsy samples does not always reveal the presence of stromal invasion.…”