1
|
Ali AH, Marhoon SE, Taman M. Emergency Presentation of Invasive Cervical Cancer in Late Pregnancy: A Case Report and Literature Review. Cureus 2023; 15:e46900. [PMID: 37954815 PMCID: PMC10638857 DOI: 10.7759/cureus.46900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Antepartum hemorrhage (APH) often prompts consideration of the presence of obstetric disorders. Here, we describe a case with active APH in which invasive cervical cancer was the cause. A 41-year-old woman, fifth gravida, fourth para (G5, P4), presented to the emergency department at 38 weeks of gestation with an acute severe attack of vaginal bleeding, which occurred immediately after a per-vaginal examination at another local institute. Despite initial stabilization measures and investigations to exclude common causes of APH, a protruding cervical mass was discovered during a Cusco speculum examination. The patient underwent an emergent cesarean section (CS). Postoperatively, the patient was referred to the gynecological oncology unit for further evaluation and management. Magnetic resonance imaging (MRI) confirmed the presence of a large cervical mass. A punch biopsy revealed squamous cell carcinoma (SCC) of the cervix. All these confirmed the condition as cervical carcinoma stage IB3. This case and literature review highlight the obstacles that might delay the diagnosis of cervical cancer and the importance of continuing the screening program strategies even during pregnancy to avoid complications of invasive cervical cancer. In addition, bleeding due to cervical cancer should always be considered one of the important differential diagnoses of APH even in full-term pregnancy.
Collapse
Affiliation(s)
- Ali H Ali
- College of Medicine, Mansoura University, Mansoura, EGY
| | | | - Mohamed Taman
- Department of Obstetrics and Gynecology, Mansoura University, Mansoura, EGY
| |
Collapse
|
2
|
Bain E, Coleridge SL, Morrison J. Small cell neuroendocrine tumour of the cervix in pregnancy: the importance of multidisciplinary management. BMJ Case Rep 2021; 14:e237058. [PMID: 34518171 PMCID: PMC8438837 DOI: 10.1136/bcr-2020-237058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
A woman in her mid-20s presented with bleeding at 18 weeks gestation from a cervical 'polyp'. Histopathology demonstrated a rare small cell neuroendocrine of the cervix. There were only 18 cases of neuroendocrine tumours of the cervix in and around pregnancy in the literature, so the evidence base for treatment was scarce. She was treated with neoadjuvant chemotherapy, using a regimen used for small cell neuroendocrine tumours of the lung, to allow for fetal lung maturity. Disease initially responded, then progressed and she was delivered at 32 weeks by caesarean radical hysterectomy. Adjuvant treatment included further chemotherapy and radical pelvic radiotherapy. The woman and her child are doing well over 6 years after treatment, although the woman has significant side effects of both radical surgery and radiotherapy. This case emphasises the need for excellent communication between multidisciplinary professionals, patients and their families and using external colleagues to help with rare clinical problems.
Collapse
Affiliation(s)
- Esme Bain
- Obstetrics and Gynaecology, Somerset NHS Foundation Trust, Taunton, UK
| | - Sarah Louise Coleridge
- Department of Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, UK
- Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, UK
| |
Collapse
|
3
|
Wang K, Wang N, Wang Y, Xia Y, Song F, Liu J. Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis : A meta-analysis. DER ORTHOPADE 2019; 48:207-212. [PMID: 30523353 DOI: 10.1007/s00132-018-03662-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To compare clinical and functional outcomes of anterior versus posterior debridement and spinal fixation for surgical treatment of thoracolumbar tuberculosis. METHODS A computer-based online search of the Cochrane Library, PubMed, EMBase, Wanfang, VIP, and the CNKI database was performed. The methodological quality of included studies was evaluated, and data analyses were performed using RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen, Denmark). RESULTS Eleven trials were studied, with eight performed in China, two in Egypt, and one in India. The results showed significant differences between the two operative approaches in terms of correction of kyphotic angle and intraoperative blood loss, but not in terms of operation time, hospital stay, fusion time, and loss of correction at the final follow-up. CONCLUSION The anterior and posterior approaches are equally good methods for treatment of thoracolumbar tuberculosis. The anterior approach results in less blood loss, whereas posterior instrumentation is better suited for correction of kyphotic angle.
Collapse
Affiliation(s)
- Kai Wang
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Na Wang
- Department of Oncology, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Yuliang Wang
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Yayi Xia
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Feixue Song
- Department of Oncology, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Jingsheng Liu
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China.
| |
Collapse
|
4
|
Eto S, Kai K, Nasu K, Nishida M, Nishida H, Narahara H. Small cell carcinoma of the uterine cervix during pregnancy. Rare Tumors 2019; 11:2036361319866539. [PMID: 31413821 PMCID: PMC6676253 DOI: 10.1177/2036361319866539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/02/2019] [Indexed: 11/15/2022] Open
Abstract
Small cell carcinoma of the uterine cervix is a rare histological entity that has a poor prognosis. We report the case of a patient with small cell carcinoma of the uterine cervix who underwent a radical hysterectomy during pregnancy. A 33-year-old Japanese woman with genital bleeding was referred at 15 weeks' gestation. A speculum exam revealed a 5.4-cm-dia. mass in the cervix, and a cervical biopsy revealed small cell carcinoma of the uterine cervix. Imaging studies demonstrated a tumor confined to the cervix, swelling of intra-pelvic lymph nodes, and no distant spread of the tumor. She was diagnosed as having small cell carcinoma of the uterine cervix, stage IB2, and underwent a radical hysterectomy with pelvic lymphadenectomy. She refused any adjuvant therapies, had a systemic relapse 4 months after surgery, and died of the disease 5 months after surgery. Early-stage small cell carcinoma of the uterine cervix should be treated with a definitive therapy soon after diagnosis whether the patient is pregnant or not. Saving the mother's life should be the top priority.
Collapse
Affiliation(s)
- Satoshi Eto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kentaro Kai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.,Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital, Oita, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.,Division of Obstetrics and Gynecology, Support System for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Masakazu Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
5
|
Ma J, Yu L, Xu F, Yi H, Wei W, Wu P, Wu S, Li H, Ye H, Wang W, Xing H, Fan L. Treatment and clinical outcomes of cervical cancer during pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:241. [PMID: 31317011 DOI: 10.21037/atm.2019.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate clinicopathological factors associated with survival rate and treatment of patients with cervical cancer during pregnancy (CCP). Methods A total of 92 patients diagnosed CCP were retrospectively reviewed. One patient was from Nanfang Hospital of Southern Medical University, 5 patients were from Tongji Hospital, and 86 patients were from case reports in the PubMed database from 1961 to 2019. Patients and tumor characteristics were evaluated. Kaplan-Meier and Cox regression methods were used to analyze the 5-year disease-specific survival (DSS). Results Most patients (73 cases) were stage I according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) standards. Twelve patients (13.04%) terminated pregnancy once diagnosed. These patients were diagnosed at the mean gestational age (GA) of 11±3 weeks, during early pregnancy. For the rest of the patients (80 cases) who continued pregnancy, the mean GA was 35±2 weeks at delivery. There was a significant difference in survival whether the treatment was performed once diagnosed or not. The 5-year DSS was 75% in adenocarcinoma (AC), 68.5% in squamous cell carcinoma (SCC), and 43.7% in the rare subtype. Among the 38 patients who underwent neoadjuvant chemotherapy (NACT), one patient suffered from spontaneous abortion, and one baby experienced acute myeloid leukemia (AML) ex-FAB (French-American-British)-M7 subtype and received bone marrow transplantation. Other delivered newborns showed no abnormality or malformation. Cox multi-factorial analysis demonstrated that tumor size (2 cm) was an independent overall survival predictor for CCP patients (P<0.05). Conclusions Tumor size was an independent prognostic factor of survival in CCP patients. Pregnancy has adverse effects on the prognosis of cervical cancer. Personalized treatment is a priority for CCP patients.
Collapse
Affiliation(s)
- Jing Ma
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China.,Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Lan Yu
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, North Sichuan Medical University, Nanchong 637000, China
| | - Hongyan Yi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenfei Wei
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Peng Wu
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Sha Wu
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangdong Provincial Key Laboratory of Proteomics, Guangzhou 510515, China
| | - Hua Li
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Hong Ye
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Wei Wang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Hui Xing
- Department of Gynecology and Obstetrics, Xiangyang Hospital, Xiangyang 441000, China
| | - Liangsheng Fan
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| |
Collapse
|
6
|
Pan L, Liu R, Sheng X, Chen D. Small Cell Neuroendocrine Carcinoma of the Cervix in Pregnancy: A Case Report and Review. Case Rep Obstet Gynecol 2019; 2019:8028459. [PMID: 31057978 PMCID: PMC6463637 DOI: 10.1155/2019/8028459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/26/2019] [Accepted: 03/17/2019] [Indexed: 11/23/2022] Open
Abstract
Small cell neuroendocrine carcinoma of the cervix is a rare subtype of cervical cancer. Here we report a case in which a 27-year-old female patient presented at 34-week gestation with abnormal vaginal bleeding, underwent normal labor, and gave birth to a healthy neonate. Her pregnancy was complicated with a cervical tumor which turned out to be small cell neuroendocrine cervical carcinoma. We reviewed and discussed the features, diagnosis, and prognosis of small cell neuroendocrine carcinoma of the cervix.
Collapse
Affiliation(s)
- Linglan Pan
- The Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China
| | - Renyan Liu
- Department of Pharmacology, Upstate Medical University, State University of New York, Syracuse, New York 13210, USA
| | - Xiujie Sheng
- The Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China
| | - Dunjin Chen
- The Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China
| |
Collapse
|
7
|
Small cell carcinoma of the uterine cervix in a pregnant patient diagnosed with liquid based cytology and cell block immunocytochemistry. Case Rep Pathol 2014; 2014:971464. [PMID: 25254132 PMCID: PMC4164505 DOI: 10.1155/2014/971464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/08/2014] [Indexed: 11/18/2022] Open
Abstract
Definitive cytomorphologic diagnosis of small cell carcinoma of the uterine cervix is possible but can be challenging in routine cervicovaginal cancer screening specimens. Several small series of reported cases of cervical small cell carcinoma have shown this uncommon malignancy to represent fewer than 2% of all invasive cervical cancers. This tumor type is associated with poor prognosis and rapid disease progression and can develop to an advanced stage in the interval between screening visits. Only rare case reports of small cell carcinoma arising in gravid cervices are known. In the current case a 29-year-old, gravida 6, para 2, pregnant (10-week gestation) female presented with postcoital bleeding. A definitive diagnosis of small cell carcinoma of the cervix was made possible by liquid based Pap testing with ancillary cell block preparation allowing for immunocytochemical characterization of the lesional cell population.
Collapse
|