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.