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Cervical cancer
2022-RA-214-ESGO Minimum deviation cervical adenocarcinoma (adenoma malignum) with unusual presentation: a case report
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  1. Emmanouil Kalampokas1,
  2. Georgios Giannis2,
  3. Olga Triantafyllidou3,
  4. Anastasia Bagiasta3 and
  5. Nikolaos Vlahos3
  1. 1Unit of Gynecologic Oncology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  2. 2Medical School, National and Kapodistrian University of Athens, Athens, Greece
  3. 3Unit of Obstetrics and Gynecology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

Abstract

Introduction/Background Minimum deviation cervical adenocarcinoma- Adenoma malignum (AM) is a rare variant of adenocarcinoma of the uterine cervix; it comprises 1%-3% of cervical adenocarcinomas. The most predominant symptoms are vaginal bleeding and discharge. Pre-operative diagnosis of AM can be difficult and definite diagnosis is based on histopathology.

Results We report a rare case report of a 62-year-old Caucasian woman who presented initially with ascites and vague abdominal symptoms suggesting ovarian cancer. Blood tests were normal. CA-125 measured at 43.4 U/mL and CA 19–9 at 101.6 U/mL. CT of chest-abdomen-pelvis showed severe ascites, a cystic mass in the left parametrium, and a large cystic mass at the right adnexum. An MRI of abdomen-pelvis showed a cystic lesion on the right ovary, possibly cystadenoma or cystadenocarcinoma, with intra-abdominal fluid collection and peritoneal nodular enhancing lesions. Cervical macroscopical examination and smear were normal. Gastroscopy and colonoscopy were normal too.

After MDT discussion, decision was made for laparoscopic assessment and primary debulking surgery. During the laparoscopic assessment a frozen biopsy was obtained, which indicated a possible borderline mucinous tumor of the ovary with possible signs of adenocarcinoma; decision made to proceed to debulking surgery as R0 was feasible. Total abdominal hysterectomy with bilateral salpingo-ophorectomy, omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and pelvic peritonectomy was performed.

Cytology of peritoneal fluid showed no evidence of malignancy. Histology showed a well-differentiated gastric type, non-HPV related adenocarcinoma of the uterine cervix (depth: 4 mm), which spread to the endometrium, both tubes and ovaries (with an 8 cm tumor in the right ovary). MDT decision was for adjuvant radiotherapy and chemotherapy.

Abstract 2022-RA-214-ESGO Figure 1
Abstract 2022-RA-214-ESGO Figure 1

Conclusion This case constitutes a rare clinical presentation of AM with ascites, and ovarian metastases. Symptoms, diagnostics tests and imaging indicated a possible diagnosis of ovarian cancer. Only histology was able to produce a definite diagnosis of AM.

https://doi.org/10.1136/ijgc-2022-ESGO.9

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