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EP319 Gastric type endocervical adenocarcinoma without delay in diagnosis: uncommon and difficult to diagnosis by screening test
  1. H Jeon and
  2. S Jeon
  1. Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea


Introduction/Background Gastric type endocervical adenocarcinoma (GAC) is a special variant of cervical adenocarcinoma which is a well-differentiated form of adenocarcinoma. It is uncommon that 1–3% of all cervical adenocarcinoma were GAC. Because of its endophytic growth pattern and its low reproducibility of glandular atypia, it is very difficult to be preoperatively diagnosed by cervical cytology.

Methodology We present a case of GAC without delay in diagnosis.

Results A 59-year-old woman who suffered watery vaginal discharge for 3 months visited our hospital. In pelvic examination, the cervix was firm and left parametrium was thickened. Ultrasound showed multiple hyperechogenic cysts. The result of cervical cytology was atypical endocervical cell and the specimen of a punch biopsy was determined as cervicitis. We performed cervical conization and fortunately, she was diagnosed as GAC. The patient underwent diagnostic laparoscopy. There were multiple white nodules scattered over the surface of uterus (figure 1A), omentum and peritoneum (figure 1B) and both salpinges were edematous (figure 1C). Subsequently, laparoscopic bilateral salpingectomy, partial omentectomy and peritoneal biopsy were performed. The results of all specimen were metastatic GAC. She was treated with chemotherapy and pelvic radiation therapy. However the general condition of this patient became worse and she died of disease 15 months after the initial diagnosis in our clinic.

Conclusion GAC is difficult to diagnosis by cervical cytology. So cervical conization is needed to make an appropriate diagnosis of it preoperatively. In our case, the patient had atypical glandular cell on cervical cytology although punch biopsy didn’t reveal GAC. We carried out conization and could diagnosis appropriately before suboptimal or radical surgery so performed proper treatment without delay. GAC is known as unfavorable prognosis and most cases are detected at advanced stages. Because of that, the early detection of GAC is important to avoid a delayed treatment and unnecessary surgical procedure.

Disclosure No potential conflict of interest relevant to this article was reported and this case presentation was supported by the Soonchunhyang University Research Funds.

Abstract EP319 Figure 1

Intraoperative picture shows multiple white nodules scattered over the intraperitoneal surface and both edematous salpinges

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