ENDOCERVICAL GASTRIC-TYPE MUCINOUS CARCINOMA, CASE REPORT

Case preparation: A 59 years old women, G2P2, had a medical examination for a pap smear undertaken in a different clinic that showed adenocarcinoma ïn situ, in May 2017. Her physical exam, at the time of adimission, colposcopy and cervix biopsy prove to be normal and high risk-HPV (hr-HPV) test was negative. Our pathology team reviewed her previous pap-smear and obtain as result a atypical squamous cells of undetermined significance (ASCUS). She maintained regular medical consults and exams without abnormalities until february 2019 when the colposcopy showed a aceto-white and hypervascular lesion in the cervix with a correspondent biopsy revealing a chronic inflamation of the cervix. Therefore she was submitted to a cervix conization that showed a well-differentiated gastric-type mucinous carcinoma. A Magnetic Ressonance Imaging (MRI) was performed revealing a invasive lesion with restricted-diffusion an initial parametrium invasion. Her final stage was IIB according to the latest FIGO cervical câncer stagin. Our patient is been treated with chemoradiotherapy. Discussion: The Endocervical-type mucinous adenocarcinoma (ECA) is an entity who has been more in evidence in the last 20 years. Althout is considered rare in western countries, in Japan, ECA represent up to 20% of all endocervical carcinomas. Since 2014 the World Health Organization classified the ECA as a group incluing the gastric-type adenocarcinoma of the cervix (GAS), and it is caracterized as a hr-HPV negative disease, with the diagnosis based on glandular epithelium resembling gastric foveolar and pyloric epithelium, abundant eosinophilic cytoplasm, different from a usual basophilic cytoplasm of the endocervical glands. In a colposcopy the hallmark for diagnostic a cervical neoplasia is the identification of a dense, opaque acetowhite well demarcated area after 5% acetic acid aplication. The most common MRI finding is an invasive solid or a diffuse infiltrative pattern. GAS is a rare entity that has been showed to be an aggressive type with a poor prognosis, once a large percentage of the patients presented at an advanced stage and pelvic, abdominal, also distant metastases are common. Final coments: GAS is a rare type of cervical cancer with hr-HPV negative, so it could pass unnoticed unless a carrefully investigation is performed. The colposcopy remains an indispensable tool in the cervical cancer surveillance.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019