Superficial spreading squamous cell carcinoma of the uterine cervix involving the endometrium: Report of two cases with emphasis on the likely molecular mechanism

Abstract

Abstract. Squamous cell carcinoma (SCC) of the cervix generally invades directly into the uterine wall, but in rare cases it spreads superficially to the inner surface of the uterus, thereby replacing the endometrium. This type is called superficial spreading SCC. In the present study we report two cases of this unusual form of cervical SCC and discuss the possible molecular mechanism involved. Two females, aged 64 (case 1) and 59 (case 2) years old, presented with post-menopausal vaginal bleeding. Histopathological studies of the resected specimens revealed non-keratinizing SCC of the cervix (pTIIA1 in case 1 and pTIIB in case 2). A notable finding in the two tumors was that atypical squamous cells were extending and replacing the endometrium directly from the cervix. Glandular involvement of atrophic endometrial glands was observed, however no invasive growth was observed in the endometrium in either case. Immunohistochemical studies revealed that CD138 was strongly expressed in the carcinoma cells superficially spreading in the endometrium in the two cases. It has been reported that the loss of expression of CD138, a cell-surface heparan sulfate proteoglycan participating in cell-cell and cell-extracellular matrix interactions, is correlated with tumor invasion and progression to cervical SCC. Our present findings suggest that CD138 expression in carcinoma cells may participate in superficial spread by regulating cell-cell interactions.

Squamous cell carcinoma in situ of the cervix with superficial intraepithelial extension to the endometrium of lower uterine segment: A rare presentation

“…Ishida and Okabe demonstrated strong expression of CD138 in carcinoma cells that participate in superficial spreading by regulating cell to cell interactions while cells in the invasive focus lack CD138 expression. [7] CD138 in our case also showed intense expression of the in situ component in the cervix and lower uterine segment without loss of expression in the deeper layers of the epithelium.…”

A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix

“…[ 11 12 13 14 9 10 ] The cervix was firm flushed with vagina in 3 (11.54%) cases,[ 13 15 16 ] and a visible cervical mass was reported in 11 (42.31%) women. [ 4 12 13 17 18 19 20 21 ]…”

Carcinoma epidermoide de cuello uterino con extensión superficial a endometrio.

“…En la literatura, se describe una edad de presentación entre 52 a 72 años, con un promedio de edad de 61,9 años, la mayoría de las pacientes son de raza blanca y postmenopáusicas. La manifestación clínica más frecuente es sangrado genital, pero también ha sido reportado piometra, descarga vaginal, hematómetra, estenosis cervical, masa pélvica y cuadros asintomáticos (1,3,4,5) . La resonancia nuclear magnética, puede ser de ayuda, pero no debe ser malinterpretada como carcinoma de endometrio, especialmente si la neoplasia cervical uterina es pequeña o no sospechada (6) Macroscópicamente, el endometrio comprometido se describe gris blanquecino, focal o parcialmente rugoso o trabeculado.…”

“…Su alteración sería un evento temprano en la carcinogénesis cervical, con sobreexpresión en etapas precoces de neoplasia intracervical (NIC) 1 y 2, y reducción en etapas posteriores como NIC 3 y carcinoma epidermoide cervical microinvasor e invasor. La expresión de CD138 sugiere que participaría en la extensión superficial mediante la regulación de las interacciones célula-célula, estando ausente en células neoplásicas invasoras (3).…”