Objectives To report 5 pediatric clear cell cervical cancer treated at our Unit.
Methods Retrospective study, 5patients were identified, age range 8–15 years. Referred to our Unit between April 2015 and January 2017, irregular vaginal bleeding was the initial symptom. None of them had DES exposure. All cases underwent pelvic evaluation and multiple biopsies were performed.
Results 4 patients were FIGO IB2; 1 initial stage unknown. Biopsies demostrated clear-cell carcinoma. Two patients had undergone a radical-hysterectomy; the first one received chemotherapy (6 cycles) and has NED after 2 years follow up. The second patient received chemotherapy 3 cycles+pelvic irradiation, 1 year later she had a supraclavicular node recurrence. Three patients received neoadyuvant chemotherapy +radical hysterectomy with pelvic lymph-node dissection+ radiotherapy. Two of them had a pelvic persistence, and died. The third one presented a pulmonary progression+ second line chemotherapy. Patients were followed up with physical exam, pap smear, MIR; in collaboration with pediatric and palliative care departments.
Conclusions The carcinoma of the cervix has a very low incidence in young patients. It must be considered in a young patient who refers irregular vaginal bleeding. Adenocarcinoma represents 10% of pediatric cervical carcinoma, clear cell subtype is the most common, its outcome is reported to be poor, and it presents two incidence peaks: adolescent and postmenopausal women. The association between fetal diethylstilbestrol (DES) exposure and the risk of cervical cancer is strong. Nowadays we also know that vaginal adenosis and genitourinary defects are related with cervical cancer too. These cases emphasizes the importance of multidisciplinary communication.
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