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Abstract
Introduction/Background*Radical parametrectomy (RP) and upper vaginectomy (UV) is a challenging operation indicated when an occult cervical cancer (CC) is diagnosed after hysterectomy for another medical reason. It’s a technically difficult procedure due to adhesions from the previous surgery and the absence of a uterus to assist dissection and achieve adequate negative margins.
Result(s)*A 57-year-old woman, with no known medical comorbidities, was referred to our hospital from an outside private institution after having undergone a simple hysterectomy (SH) with the diagnosis of incidental squamous cervical carcinoma.
The patient had initially presented with 4 weeks history of postmenopausal bleeding. No abnormalities were noted during a speculum examination, she had a negative smear test four months previously, and a normal pelvic ultrasound. Endometrial biopsy was inconclusive and the patient subsequently underwent a SH and bilateral salpingo-oophorectomy.
Pathology revealed an incidentally well differentiated squamous CC, measuring 3.5 cm in diameter and 1 cm of deep invasion (IB1 FIGO 2018). There was extensive lymphovascular space invasion and the cervical margins were also affected.
Postoperative staging scan (PET/TC), did not show any evidence of residual local or metastatic disease. A complete pelvic lymphadenectomy, with negative intraoperative result, RP and UV by laparoscopic-robotic surgery was performed. Due to the results of the LACC Trial, an open colpectomy was performed.
The surgery lasted approximately 345 min and the patient was discharged 3 days after surgery. Two weeks later, she presented painful lymphoedema, and was diagnosed with bilateral pelvic lymphocysts, requiring drainage by interventional radiology.
Parametrectomy pathology demonstrated a residual focus (4 mm) of squamous carcinoma at the vagina, and free margins. Subsequently, a metastasis was found in one left pelvic node – upstaging to FIGO IIIC1. Adjuvant chemoradiation with weekly cisplatin and whole pelvic radiation was planned.
Conclusion* CC may be found incidentally after SH carried out for benign gynecologic conditions or preinvasive cervical lesions. SH is suboptimal procedure and associated with significantly inferior survival rates. Further treatment, such as radiotherapy (RT) or additional surgery, is warranted. PET-CT have false negative, so surgery allow re-staging with a prognostic value and condition subsequent complementary treatment.