Abstract
Background : It is sometimes difficult and challenging to make a treatment decision when there is a discrepancy between preoperative cervical cytology and histology. Herein, we present a case report of cervical clear cell adenocarcinoma (CCA). Although adenocarcinoma was suspected cytologically, no malignancy could be detected by histological examination. The final diagnosis made by histopathological examination of the total hysterectomy specimen was microinvasive cervical CCA (stage IA1 based on FIGO classification).
Case : A 69-year-old woman was referred to our hospital for positive endometrial smears. Cytologically, the tumor cells had prominent nuclei, marked nucleolus large nuclei, prominent nucleoli and a clear cytoplasm, arranged in tubular and sheet-like patterns ; based on these findings, adenocarcinoma (probably clear cell) of the cervix was suspected. However, transvaginal ultrasonography and MRI revealed no evidence of a tumor. Histological examination of endometrial and endocervical curettage specimens also revealed no abnormal findings. However, since malignant tumor could not be excluded, total hysterectomy and bilateral salpingo-oophorectomy was performed. Postoperatively, a shallow (less than 3 mm) tumor was detected in the cervical glands.
Conclusion : Cytology is often more valid than cervical curettage for the diagnosis of early cervical adenocarcinoma. Although HPV testing is important for early detection of cervical neoplasms, cytological diagnosis may play an important role in the checkup for early cervical adenocarcinoma.
