Introduction/Background Mucin secreting adenocarcinoma of the cervix is a rare histological subtype of cervical cancer. It is recognised that mucin producing carcinomas have high signal intensity on T2 weighted MRI imaging. This case report describes a patient achieving complete pathological response within the primary tumour following pelvic external beam radiotherapy, correlating to a change in signal on MRI scan but not a reduction in tumour dimension.
Methodology This is a case report of a female presenting with a large 8 cm biopsy proven mucin secreting adenocarcinoma of the cervix, staining positive for CEA, CK7 and p16. Initial MRI scan stage was FIGO 3c1 (FIGO 2018) with bilateral pelvic lymph nodes. Distant metastasis was not seen.
Results Following discussion within the gynaecological multidisciplinary team meeting, the patient underwent definitive treatment with concurrent chemoradiotherapy. Baseline MRI scan (figure 1) and a repeat MRI scan following external beam radiotherapy (figure 2) were compared prior to consideration of intracavitary brachytherapy. The primary tumour’s dimension remained large. However, there was an increase in signal in both the primary tumour and lymph nodes. Following discussion in a multidisciplinary meeting, the patient had an examination under anaesthetic, where the tumour was deemed operable with no parametrial or vaginal involvement. Rather than proceeding to brachytherapy, the patient went on to have a radical hysterectomy with pelvic and para aortic lymphadenectomy. Final histology revealed presence of acellular mucin indicating complete pathological response within the primary tumour. 1 of 21 lymph nodes contained tumour cells in keeping with metastasis from cervical cancer.
Conclusion Mucinous adenocarcinoma of the cervix can display an atypical response to radiotherapy with an increase in signal intensity on MRI imaging without a reduction in volume. Further publication of cases are required to help direct future clinical management of these rare histology subtypes.
Disclosure Nothing to disclose.
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