2024 Volume 63 Issue 2 Pages 85-90
Background : Cervical cytology screening during prenatal checkups increases the screening rate, but with a possible risk of underestimation influenced by pregnancy. Here, we review two cases of pregnant women that were initially diagnosed by cytology as ASC-H. Furthermore, we examined the reasons why these cases didn’t show cytology results indicative of invasive cancer.
Cases : Case 1 : Early-pregnancy cervical cytology in a 28-year-old woman revealed ASC-H, which was followed by diagnosis of squamous cell carcinoma on biopsy. The patient was finally diagnosed as a case of cervical cancer, FIGO stage ⅠA1, by extended cervical biopsy. Possibly, the microinvasive lesions were too focal to allow collection of sufficient cells by cytology to diagnose invasive cancer.
Case 2 : Early-pregnancy cervical cytology in a 41-year-old woman revealed ASC-H, which was followed by diagnosis of CIN3 on biopsy. A repeat biopsy revealed squamous cell carcinoma, and after subsequent hysterectomy at the time of delivery, the patient was diagnosed by postoperative histopathology as a case of cervical cancer, FIGO stage ⅠB1. It is possible that the low-grade lesion proximal to the invasive cancer was scratched due to insufficient vaginal expansion and cervical deviation owing to the patient’s obesity, and that this led to the diagnosis of ASC-H with pregnancy-related cytological changes suspicious of atypia.
Conclusion : Careful attention should be paid to factors leading to underdiagnosis of cervical tumors by cervical cytology at the time of the specimen collection, such as insufficient expansion of the cervix and presence of a large among of cervical mucus, especially during pregnancy. A comprehensive evaluation, consisting of an internal examination, colposcopy, and histology, should be conducted in cases with abnormal cervical cytology.
