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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

SH Chandrashekhara1, S Hari1, R Arora1, S Kaushal2, MK Singh2, V Dadhwal3,  
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

Correspondence Address:
S H Chandrashekhara
Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi
India




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;52:496-497


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 2020 Aug 12 ];52:496-497
Available from: http://www.indianjcancer.com/text.asp?2015/52/4/496/178405


Full Text

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 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}{Figure 2}{Figure 3}{Figure 4}

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

1Tan 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.
2Aikins JK, Gisser S, Qasim S, Saul H, Rocereto T. Primary squamous cell carcinoma of the endometrium. Int J Gynaecol Obstet 1995;50:55-60.
3Nakao 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.