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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 496-497
 

Invasive squamous cell carcinoma of cervix showing horizontal endometrial spread with extension and involvement of the myometrium: A case report


1 Department of Radio-diagnosis, All Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All Institute of Medical Sciences, New Delhi, India
3 Department of Obstetrics and Gynaecology, All Institute of Medical Sciences, New Delhi, India

Date of Web Publication10-Mar-2016

Correspondence Address:
S H Chandrashekhara
Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178405

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How to cite this article:
Chandrashekhara S H, Hari S, Arora R, Kaushal S, Singh M K, Dadhwal V. Invasive squamous cell carcinoma of cervix showing horizontal endometrial spread with extension and involvement of the myometrium: A case report. Indian J Cancer 2015;52:496-7

How to cite this URL:
Chandrashekhara S H, Hari S, Arora R, Kaushal S, Singh M K, Dadhwal V. Invasive squamous cell carcinoma of cervix showing horizontal endometrial spread with extension and involvement of the myometrium: A case report. Indian J Cancer [serial online] 2015 [cited 2019 Dec 15];52:496-7. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/496/178405


Sir,

Superficial spread of intraepithelial and invasive carcinoma cervix over the endometrial surface is extremely rare. Fewer than 20 cases have been reported in the literature so far.

[1] We report an interesting case of invasive squamous cell of the cervix with horizontal endometrial spread with extension to involve inner one-third of myometrium.

A 55-year-old female patient presented with post-menopausal bleeding for four months. General physical examination was unremarkable. On pelvic examination no cervical growth was seen.  Pap smear More Details was positive for malignancy. Endometrial aspiration cytology revealed a large cell non-keratinizing squamous cell carcinoma. Ultrasound showed normal cervix with thickened endometrium. Computed tomography showed bulky uterus, normal cervix with marked low-attenuation thickening of the endometrium with irregular low-attenuation infiltration of the myometrium in the fundal region [Figure 1] and [Figure 2]. Wertheim's hysterectomy was done and the specimen was sent for histopathological evaluation. On gross examination, the external surface of the uterus appeared smooth. On sectioning, endometrium was irregularly thickened with no tumor in cervix [Figure 3]. Microscopically, sections from cervix showed predominantly carcinoma in situ with a focus of invasive large cell non-keratinizing squamous cell carcinoma. Sections from endometrium showed replacement of normal endometrium by similar tumor. Tumor was infiltrating inner one third of the myometrium [Figure 4]. The final diagnosis was carcinoma cervix; federation of gynecology and obstetrics stage Ib.
Figure 1: Contrast-enhanced computed tomography of a 55-year-old female of carcinoma cervix. Axial images showing bulky uterus (a) and normal cervix (b) with marked low-attenuation thickening of the endometrium (white arrow) with irregular low-attenuation infiltration of the myometrium in the fundal region

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Figure 2: Contrast-enhanced computed tomography of a 55-year-old female of carcinoma cervix. Sagittal image showing the bulky uterus (a) and normal cervix (b) with marked low-attenuation thickening of the endometrium (black arrow)

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Figure 3: Gross photograph of hysterectomy specimen showing irregularly thickened endometrium, no tumor is seen in the cervix

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Figure 4: Microphotograph showing carcinoma in situ cervix (H and E, ×200) (a), cervical stroma invaded by large cell non keratinizing squamous cell carcinoma (H and E ×200) (b), endometrial surface replaced by similar tumor (H and E ×200) (c), tumor is invading myometrium (H and E ×200) (d)

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Intraepithelial and invasive squamous cell carcinomas of the endometrium are very rare. Although primary squamous cell carcinoma of the endometrium is known to occur, but in the presence of a cervical carcinoma, the usual assumption is that the endometrial lesion results from a “horizontal spread.”[2] This is a rare phenomenon and to our knowledge less than 20 cases have been reported until now. Nakao et al. have reported a case of endometrial extension of adenosquamous carcinoma of the uterine cervix, in which the glandular component extended to the vagina while the squamous component grew into the entire uterine cavity and replaced the glandular epithelium.[3] Several studies suggest that extension of cervical cancer into the endometrial cavity implies poor prognosis, therefore dilation and curettage should be done regularly in order to identify these cases. The presence of the endometrial extension is an important prognostic factor, which decreases the survival rate. We hope that with the increase in number of reported cases proper guidelines for management of such cases can be formulated.

 
  References Top

1.
Tan GC, Isa MR, Ng SP, Jamil YM. Unusual form of superficial spreading microinvasive squamous cell carcinoma of uterine cervix involving the endometrium of uterus. J Obstet Gynaecol Res 2004;30:363-7.  Back to cited text no. 1
    
2.
Aikins JK, Gisser S, Qasim S, Saul H, Rocereto T. Primary squamous cell carcinoma of the endometrium. Int J Gynaecol Obstet 1995;50:55-60.  Back to cited text no. 2
    
3.
Nakao Y, Yokoyama M, Hara K, Yasunaga M, Uchiyama M, Noguchi M, et al. Endometrial extension of adenosquamous carcinoma of the uterine cervix. Int J Gynecol Cancer 2004;14:625-7.  Back to cited text no. 3
    


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