Minimal deviation adenocarcinoma of the uterine cervix: A case report

Dah-Ching Ding^{a, b}, Tang-Yuan Chu^{a, b}, Yung-Hsiang Hsu^c

^a Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c Department of Pathology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Abstract

Minimal deviation adenocarcinoma (MDA) of the uterine cervix is a rare disease. The rate of misdiagnosis is relatively high and there is no standard treatment. A 58-year-old woman presented with an abnormal Pap smear revealing atypical glandular cells and vaginal mucoid discharge. Cervical biopsy revealed cervicitis and an endometrium with atypical glands and increasing mitoses. A frozen section of curetted endometrial tissue revealed adenocarcinoma. Surgical staging with laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was then performed. However, uterine cervical MDA was confirmed by pathology and immunohistochemistry with carcinoembryonic antigen and vimentin. Because the staging surgery was inadequate (the parametrium was not radically resected), postoperative adjuvant therapy with concurrent chemoradiation was performed. The patient remained disease-free as of the last follow-up 6 months postoperatively. MDA is difficult to diagnose and depends on its clinical manifestations and pathologic features. Surgery with adjuvant chemoradiotherapy achieves good outcomes.

Keywords

Adenocarcinoma; Malignant adenoma; Minimal deviation; Uterine cervix