Introduction/Background Gastric-type endocervical adenocarcinoma (GAS) was recognized in the latest World Health Organisation classification as the second most frequent subtype of adenocarcinoma of the endocervix (EAC) and is HPV-unrelated. GAS is known for its presentation at advanced stage, worse clinical outcome, more metastasis to distant sites and its relative resistance to chemotherapy.

We describe one case of GAS with poor response to chemotherapy and an misunderstanding on imaging.

Methodology/Results A 48 year old Caucasian female patient underwent a Papanicolaou smear during routine gynecological examination. Atypies of Low Grade Squamous Intraepithelial Lesion (LGSIL) were found. Colposcopy and biopsy revealed an invasive adenocarcinoma of the cervix with presence of intestinal cells. HPV PCR was negative.

The conization confirmed a GAS of 15 on 6 mm with lymphovascular emboles. The chirurgical margins were non in sano.

Magnetic resonance imaging (MRI) was negative; positron emission tomography (PET) showed a hypermetabolic sigmoidal lesion, but rectosigmoidoscopy was negative. Nevertheless, the clinical examination showed a residual lesion of 30 mm and biopsy confirmed persistent disease.

The patient underwent nine courses of neoadjuvant chemotherapy by Carboplatine and Paclitaxel.

Clinical evaluation showed a normal cervix but hard palpation, douglas was negative. Moreover, MRI and PET confirmed the absence of residual disease.

Then, Wertheim type II was performed.

The final anatomopathological examination confirmed the diagnosis of a 40 mm GAS with tumor-free margins and metastatic invasion of one lymphnode in right parametrium. ypT1B2N1, FIGO: IB2.

Facing this poor result, the patient was offered classical treatment of adjuvant pelvic chemo-radiotherapy (Cisplatin).

Conclusion This 48 year old female was diagnosed with gastric type of invasive endocervical adenocarcinoma. She underwent neoadjuvant chemotherapy with incomplete response. The persistent disease was not detected by imaging techniques after treatment nor eventually before the treatment.

Disclosure Nothing to disclose.