Case presentation
Our patient is a 47 year-old lady presented with a 2 month history of abnormal vaginal bleeding and postcoital bleeding. Patient also complained of mild abdominal discomfort but no other symptom including gastrointestinal and urinary was reported. Unfortunately the patient had not done regular Pap smear test over the years but did not have prior abnormal Pap smear. On past medical history she had breast cancer, invasive ductal carcinoma T2N3 stage, about 6 years ago. She then underwent lumpectomy and axillary lymph node dissection. Subsequently she received chemotherapy followed by radiotherapy and later due to premenopausal status tamoxifen and GnRh agonist was prescribed .On physical examination the patient had a 3cm mass in cervix. An abdominal sonography revealed a 7*7 mm hypoechoic lesion. MRI was also done which reported cervical canal dilatation with mucosal irregularity and thickening (figure 1) .Two lymph nodes with SAD of 11 & 13 mm in right side of pelvis and mild fat stranding in right side of paracervicl region.
Core needle biopsy was done which reported to be small cell carcinoma of cervix. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was done for the patient along with pelvic lymphadenctomy .Pathology is as follows (microscopic view is demonstrated in figure 2 and 3):
Histology is identified as poorly differentiated small cell non keratinized carcinma with horizontal extent about 2 cm, depth of stromal invasion 7 mm, detected perineural and lymphovascular invasion and vaginal wall, uterine corpus ,both parametria and adnexae free from tumor. In addition,18 out of 19 dissected lymph nodes were involved and surgical margins were free.
After surgical wound healing adjuvant treatment with 6 cycles of cisplatin and etoposide and concurrent radiation therapy (starting with cycle 2 prescribed at 4600 cGY/23 fractions) commenced according to protocols for small cell lung cancer regimen. Intravaginal brachytherapy was also instrumented after completion of external beam radiotherapy.
At the time of writing this paper, patient is in follow-up and free of tumor recurrence and metastasis.