Fatal invasive cervical cancer secondary to untreated cervical dysplasia: a case report

Abstract

Introduction: Well-documented cases of untreated cervical intra-epithelial dysplasia resulting in fatal progression of invasive cervical cancer are scarce because of a long pre-invasive state, the availability of cervical cytology screening programs, and the efficacy of the treatment of both pre-invasive and early-stage invasive lesions.

Case presentation: We present a well-documented case of a 29-year-old Caucasian woman who was found, through routine conventional cervical cytology screening, to have pathologic Papanicolaou (Pap) grade III D lesions (squamous cell abnormalities). She subsequently died as a result of human papillomavirus type 18-associated cervical cancer after she refused all recommended curative therapeutic procedures over a period of 13 years.

Conclusion: This case clearly demonstrates a caveat against the promotion and use of complementary alternative medicine as pseudo-immunologic approaches outside evidence-based medicine paths. It also demonstrates the impact of the individualized demands in diagnosis, treatment and palliative care of patients with advanced cancer express their will to refuse evidence-based treatment recommendations.

Figure 1

Restaging of the tumor. (a) formalin-fixed, paraffin-embedded biopsy of the invasive cervix cancer; (b) corresponding CT scan of the pelvis; (c) formalin-fixed, paraffin-embedded biopsy of the para-aortic lymph node metastases and her abdomen showing bladder invasion; and (d) corresponding CT scan of the enlarged para-aortic lymph nodes.

Figure 2

CT scans. (a) local tumor progression in her pelvis and vesical invasion and hemorrhage; (b) left ureter obstruction; (c) ileus through descending colon and rectosigmoid obstruction; (d) malignant pleural effusion; (e) spleen metastasis; (f) liver metastasis.