Clear cell adenocarcinoma of the uterine cervix in a 24-year-old woman. Case report and review of the literature

A Rare Case of Clear Cell Cervical Carcinoma to a Woman, 50 Years After Diethylstilbestrol Exposure for Lactation Suppression

A 73-year-old lady presented with post-menopausal bleeding and a suspicious-looking endocervical polyp. She had a loop biopsy of the cervix that showed clear cell cervical carcinoma, and she was referred to our Gynaecology oncology team for further management. Following imaging for staging and an MDT discussion, she had a total abdominal radical hysterectomy that confirmed the diagnosis. The diagnosis of clear cell adenocarcinoma of the cervix is rare, accounting for 4% of cervical carcinomas. However, it is often correlated with diethylstilbestrol (DES) exposure in utero. It is well documented that daughters of mothers who received DES during pregnancy are at a higher risk of adenocarcinomas in the genital tract. In our case, the patient had been administered DES for lactation suppression 50 years earlier. After reviewing the relevant literature, we present the case of our patient, the management of this uncommon case, and help identify possible correlation/long-term implications to patients who received DES.

[Clear Cell Carcinoma of Cervix in a 12-Year-Old Girl: A Case Report]

The 12-year-old patient was admitted to the hospital on September 19, 2019 for "vaginal bleeding for 2 + months and pelvic mass to be diagnosed". The patient and her family explicitly denied any previous history of diethylstilbestrol exposure. After admission, relevant examinations were conducted and hysteroscopic exploration was performed under general anesthesia. During the procedure, cervical neoplasms were extracted and pathology results indicated cervical cancer. Then, extensive transabdominal hysterectomy+bilateral salpingectomy+bilateral ovarian transposition+pelvic lymph node dissection+para-aortic lymph node sampling were performed. Postoperative pathology analysis of the removed tissue showed that clear cell carcinoma of cervix (CCAC) had infiltrated into 1/3 of the cervical stroma and there was downward involvement of the vaginal wall; the cancer metastasized to the left obturator lymph node and the left internal and external iliac lymph nodes. Immunohistochemical staining of the removed tissue showed the following results: cytokeratin 7 (+), cytokeratin 20 (-), Napsin-A (+), cell adhesion molecule CD15 (+), heatocyte nuclear factor-1 β (+), Sal-like protein 4 (-), tumor suppressor gene P16 protein (+), estrogen receptor (+), progesterone receptor (-), tumor suppressor gene P53 protein (focal positive), tumor suppressor gene WT-1 protein (-) and Ki67 antigen (about 40% positive). The patient was diagnosed with CCAC stage ⅢC1p. Four cycles of postoperative systemic chemotherapy (fluorouracil+cisplatin) and 25 times of three-dimensional afterloading radiotherapy were performed. The patient did follow-up visits and did not show obvious signs of recurrence. The clinical manifestations of this disease are basically the same as those of cervical squamous cell carcinoma, and if the patient is younger, it can be easily misdiagnosed as dysfunctional uterine bleeding, indicating the need for differential diagnosis.

Clear cell adenocarcinoma of cervix in 1-year-old girl without in utero exposure to diethylstilbestrol: an uncommon tumour at an uncommon age and site

Adenocarcinoma of cervix constitutes about 10-15% cases of carcinoma cervix. Clear cell variant is even a rarer variant of adenocarcinoma. It rarely occurs in the paediatric age group and a known risk factor is in utero exposure to diethylstilbestrol (DES). We report here a case of primary cervical tumour in a 1-year-old girl, which was initially suspected to be an embryonal rhabdomyosarcoma botryoides. Histopathology with immunohistochemical analysis revealed clear cell adenocarcinoma. There was no maternal history of DES intake during pregnancy. We discuss the histopathological characteristics and clinical course of this unusual tumour.

Clear cell carcinoma of cervix in a postmenopausal woman: A case report

Clear cell carcinoma of cervix is a very rare neoplasm accounting only 4% of all cervical adenocarcinomas. Intrauterine exposure to diethylstilbestrol (DES) is supposed to be causative factor for clear cell adenocarcinoma in childhood and young-age patients. We are reporting a case of clear cell carcinoma of cervix in a 49-years-old multiparous post-menopausal woman, who had no exposure to DES (in-utero) or synthetic non-steroidal estrogen.