Why are recurrent cervical cancers of the pelvic stump misdiagnosed as interstitial cystitis?: The urologist's point of view based on a case report

Abstract

A 50-year-old female who had undergone laparoscopic total hysterectomy at a local clinic owing to leiomyoma of the uterus was referred to our hospital after having dysuria, urgency, frequency, lower abdominal pain and right flank pain over several months. After routine examinations, cystoscopy, computed tomography and magnetic resonance imaging were performed, and non-ulcerative interstitial cystitis accompanied by postoperative fibrosis secondary to a previous surgery was suggested. Pentosan sulfuric polyester (Elmiron, Alza Pharmaceuticals, Mountain View, CA) reduced her severely debilitating symptoms and improved her quality of life. Both the hydronephrosis and the symptoms were relieved by ureteral stent insertion and percutaneous nephrostomy. However, a few days later, she presented with vaginal bleeding along with her previous symptoms, and punch biopsy of the vaginal stump resulted in a diagnosis of adenocarcinoma. Both ureterocutaneostomy with radical cystectomy and lower anterior resection for rectum invasion were conducted. After the slide review of the original specimen from the local clinic, she was diagnosed with recurrent cervical cancer of the vaginal stump.

Fig. 1.

Initial computed tomography showed prominent both lateral ends of vaginal stump with irregular enhancement, especially right side (arrow). There was no hydronephrosis in both kidneys.

Fig. 2a.

T2-weighted magnetic resonance imaging showing irregular thickening of vaginal stump (arrows) and focal traction of bladder posterior wall at midline toward vaginal stump.

Fig. 2b.

T1-weighted magnetic resonance imaging showing sagittal section of lesions (arrow) around vaginal stump with suspicious bladder invasion.