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Zagorianakou N, Katrachouras A, Almousa N, Skentou C, Makrydimas G. A Large Exophytic Tumor of the Cervix Causing Vaginal Bleeding in Pregnancy: A Case Report. Cureus 2023; 15:e35747. [PMID: 37020479 PMCID: PMC10068404 DOI: 10.7759/cureus.35747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
Vaginal bleeding in the second and third trimesters of pregnancy is usually due to placental causes, namely placental abruption and placenta previa. Other causes include uterine rupture, vasa previa, and hematologic disorders. However, benign or malignant lesions of the vagina and the cervix may also cause vaginal bleeding or spotting. Although cervical cancer in pregnancy is rare, about 8% of pregnant women have an abnormal Pap smear and 3% of the total cervical cancers are diagnosed during pregnancy. We report a case of a 20-week pregnant woman who presented with vaginal bleeding; a visual inspection revealed a large exophytic lesion of the cervix. The Pap smear demonstrated a low-grade squamous intraepithelial lesion (LSIL) related to human papillomavirus (HPV) infection. The differential diagnosis based on the findings of the colposcopy included invasive cervical carcinoma, warty lesions, and perishable lesion. A cesarean section and the removal of the cervical tumor were scheduled and carried out as planned at 37 weeks of gestation. The histologic examination showed extensive lesions of low-grade squamous intraepithelial cervical neoplasia (LSIL/CIN1). Despite the fact that exophytic tumors of the cervix are extremely rare, in women presenting with vaginal bleeding or spotting during the second or third trimester of pregnancy, the ultrasound scan must be followed by a visual inspection of the vagina and the cervix.
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Enomoto S, Yoshihara K, Kondo E, Iwata A, Tanaka M, Tabata T, Kudo Y, Kondoh E, Mandai M, Sugiyama T, Okamoto A, Saito T, Enomoto T, Ikeda T. Trends in Pregnancy-Associated Cervical Cancer in Japan between 2012 and 2017: A Multicenter Survey. Cancers (Basel) 2022; 14:cancers14133072. [PMID: 35804845 PMCID: PMC9264791 DOI: 10.3390/cancers14133072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. This multicenter retrospective observational study investigated clinical features and trends in pregnancy-associated cervical cancer treatments at 523 hospitals in Japan. We included cervical cancer cases that were histologically diagnosed (between 1 January 2012, and 31 December 2017), and their clinical information was retrospectively collected. Of 40 patients diagnosed with pregnancy-associated cervical cancer at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of 163 diagnosed at <22 gestational weeks, 111 continued and 52 terminated their pregnancy. Ninety patients with stage IB1 disease had various treatment options, including termination of pregnancy. The 59 stage IB1 patients who continued their pregnancy were categorized by the primary treatment into strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy groups, with no significant differences in progression-free or overall survival. The birth weight percentile at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (p = 0.029). Full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. Treatment decisions for pregnancy-associated cervical cancer are needed after estimating the stage, considering both maternal and fetal benefits.
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Affiliation(s)
- Sayako Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Akiko Iwata
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan;
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Hiroshima University Graduate School of Medicine, Hiroshima 739-0046, Japan;
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan;
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8507, Japan;
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University School of Medicine, Ehime 791-0295, Japan;
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo 105-8471, Japan;
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo 060-8543, Japan;
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
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Nagasawa S, Kasahara M, Aoki Y, Kusunoki S, Sugimori Y, Matsuoka S, Ogura K, Ogishima D. Successful pregnancy with stage IB2 uterine cervical cancer: A case report. Cancer Rep (Hoboken) 2021; 5:e1542. [PMID: 34528406 PMCID: PMC9327669 DOI: 10.1002/cnr2.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/11/2021] [Accepted: 08/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although cervical cancer is one of the most common malignancies in pregnancy, its management mainly follows the guidelines for nonpregnant disease state. Within the limited time, patients, and healthcare workers must make difficult decisions to either delay treatment until documented fetal maturity or start immediate treatment based on the disease stage. Case The patient was a 37‐year‐old woman: gravida 1, para 0. Her cervical cytology revealed a high‐grade squamous intraepithelial lesion at 8 weeks' gestation. Moreover, invasive squamous cell carcinoma was suspected based on the findings of uterine cervix biopsy. Cervical conization was performed at 11 weeks' gestation, confirming a histopathological diagnosis of squamous cell carcinoma, pT1b2. Cervical cytology findings continued to be negative for intraepithelial lesion or malignancy from 2 weeks after conization until 2 weeks before a cesarean section. In addition, we performed abdominal pelvic lymphadenectomy at 16 weeks' gestation to determine whether the patient could continue her pregnancy. No lymph node metastasis or local recurrence was observed. Finally, a cesarean section and modified radical hysterectomy were performed at 35 weeks' gestation. There was no carcinoma invasion or metastasis. A baby girl weighing 2056 g was delivered with 1‐ and 5‐min Apgar scores of 8 and 9, respectively. Five years postoperatively, there was no evidence of cancer recurrence. Conclusion Management of cervical cancer during pregnancy by using a combination strategy of deep conization and pelvic lymphadenectomy could be an effective strategy for carefully and safely assessing risks of recurrence and metastasis.
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Affiliation(s)
- Saya Nagasawa
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Makiko Kasahara
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Yuji Aoki
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Soshi Kusunoki
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Yayoi Sugimori
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Shozo Matsuoka
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Kanako Ogura
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Daiki Ogishima
- Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
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Nurjihan TF, Rahman TA, Rahman NAA, Shafri MAM, Haque M. The Knowledge, Attitude, and Practice Regarding Pap Smear, Cervical Cancer, and Human Papillomavirus among Women Attending a Mother and Child Health Clinic in Kuantan, Malaysia. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_199_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Cervical cancer (CC) is a foremost reason of global cancer death in women, and a good portion remains with the developing countries. This study was conducted to assess the knowledge, attitude, and practice regarding Pap smear, CC, and Human Papillomavirus (HPV) among the women attending a Mother and Child Health Clinic in Kuantan, Malaysia. Materials and Methods: A total of 120 respondents involved in this cross-sectional study. The convenience sampling was to select the respondents. The data were collected from in 2013. Results: The mean age 32.19 years. Up to 54.2% of respondents never had Pap smear in the past 5 years, while over 67.5% of respondents never had HPV vaccination. There was a significant correlation between knowledge with attitude (P < 0.001) and attitude with practice (P < 0.001) regarding Pap smear, CC, and HPV. However, knowledge and practice regarding Pap smear, CC, and HPV was not significantly correlated (P = 0.525). There was no significant correlation between mean age and knowledge (P = 0.455) while there was a significant correlation between mean age with attitude (P = 0.011) and practice (P < 0.001) regarding Pap smear, CC, and HPV. It was also shown that there were differences between races in term of knowledge and attitude (P < 0.05). However, there was no significant difference in term of practice regarding Pap smear, CC, and HPV (P > 0.05) between races. Conclusions: Important barriers to Pap smear screening among women are highlighted through this study. The health institution involved needs to come up with better strategies to deal with these barriers to improve the awareness of women regarding Pap smear, CC, and HPV.
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Affiliation(s)
| | | | - Nor Azlina A. Rahman
- Departments of Physical Rehabilitation Sciences, International Islamic University Malaysia, Kuantan, Pahang
| | - Mohd Affendi Mohd Shafri
- Departments of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Pahang
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
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Gungorduk K, Sahbaz A, Ozdemir A, Gokcu M, Sancı M, Köse MF. Management of cervical cancer during pregnancy. J OBSTET GYNAECOL 2015; 36:366-71. [PMID: 26467977 DOI: 10.3109/01443615.2015.1065235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account.
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Affiliation(s)
- K Gungorduk
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - A Sahbaz
- b Department of Obstetrics and Gynecology , Bulent Ecevit University School of Medicine , Zonguldak , Turkey
| | - A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M Gokcu
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M Sancı
- a Department of Gynecologic Oncology , Tepecik Education and Research Hospital , Izmir , Turkey
| | - M F Köse
- c Department of Gynecologic Oncology , Medipol University School of Medicine , İstanbul , Turkey
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Xavier-Júnior JCC, Dufloth RM, do Vale DB, Tavares TA, Zeferino LC. High-grade squamous intraepithelial lesions in pregnant and non-pregnant women. Eur J Obstet Gynecol Reprod Biol 2014; 175:103-6. [PMID: 24522115 DOI: 10.1016/j.ejogrb.2014.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/06/2013] [Accepted: 01/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate if the prevalence of cervical smear results varies between pregnant and non-pregnant women stratified by age group. STUDY DESIGN Observational analytical study with a total sample of 1,336,180 pregnant and non-pregnant women, aged between 20 and 34 years, who underwent cervical cancer screening in the Primary Health Care of the national health system in the area of Campinas in Brazil during the period of 2005-2009. The source is the information system for cervical cancer screening. Data collected on abnormal cervical smears were analyzed using the Chi-square test and Fisher's exact test and the magnitude of the association between pregnancy and high-grade squamous epithelial lesions was analyzed by odds ratio (OR) and estimated values with confidence intervals (CI) of 95%. RESULTS 15,190 pregnant women and 395,961 non-pregnant women were analyzed and fulfilled the inclusion criteria. Regardless of age, no statistical differences were observed for high-grade squamous intraepithelial lesion prevalence (OR 0.90; CI 0.66-1.23). Taking into account the five-year age groups, however, low-grade squamous intraepithelial lesion was less prevalent in pregnant women aged 20-24 (OR 0.71; 0.54-0.95) and 25-29 years (OR 0.56; 0.35-0.89); also, atypical squamous cells of undetermined significance was more prevalent in non-pregnant women aged 25-29 years (OR 0.72; 0.54-0.97). CONCLUSION The study showed that the cytological prevalence of high-grade squamous intraepithelial lesion was similar in pregnant and non-pregnant women, regardless of age. The results indicate that there are no reasons for specific approaches to cervical cancer screening for pregnant women. The examination should be carried out only on pregnant women who have not been tested according to current recommendations.
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Affiliation(s)
| | - Rozany M Dufloth
- UNESP - Universidade Estadual Paulista, Pathology Department, Botucatu, SP, Brazil.
| | - Diama B do Vale
- UNICAMP - Universidade Estadual de Campinas, Department of Obstetrics and Gynecology, Oncology Division, Campinas, SP, Brazil
| | - Thalita A Tavares
- UNESP - Universidade Estadual Paulista, Pathology Department, Botucatu, SP, Brazil
| | - Luiz C Zeferino
- UNICAMP - Universidade Estadual de Campinas, Department of Obstetrics and Gynecology, Oncology Division, Campinas, SP, Brazil
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Kim JH, Kim IW, Kim YW, Park DC, Kim YW, Lee KH, Ahn TG, Han SJ, Ahn WS. Comparison of single-, double- and triple-combined testing, including Pap test, HPV DNA test and cervicography, as screening methods for the detection of uterine cervical cancer. Oncol Rep 2013; 29:1645-51. [PMID: 23443346 DOI: 10.3892/or.2013.2257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/03/2012] [Indexed: 11/05/2022] Open
Abstract
Cervical cancer is a serious disease that threatens the health of women worldwide. This study compared the sensitivities and false-positive rates of cervical cytology (Pap smear), human papilloma virus (HPV) DNA test, cervicography, first double-combined testing (cervical cytology and HPV DNA test), second double-combined testing (cervical cytology and cervicography) and triple-combined testing (cervical cytology, HPV DNA test and cervicography). The study included 261 patients screened for uterine cervical cancer. All women simultaneously underwent cervical cytology, HPV DNA test and cervicography for uterine cervical cancer screening and colposcopically directed biopsy for diagnostic evaluation. The triple-combined testing was consistently the most sensitive among the cervical screening tests. The second double-combined testing, with a sensitivity rate of 98.1% was more sensitive than the first double-combined test (92.3%). However, cervical cytology was most specific (93.5%) and showed the highest positive predictive value (77.8%). The sensitivity of cervical cytology was markedly improved in combination with HPV DNA test and cervicography. Thus, the triple-combined testing, which improves the high false negativity of cervical cytology, may be an effective tool in uterine cervical cancer screening, pending confirmation of the effectiveness in a mass screening study.
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Affiliation(s)
- Ju Hee Kim
- Catholic Research Institute of Medical Science, Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Republic of Korea
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