Fertility-preserving local excision under a hysteroscope with combined chemotherapy in a 6-year-old child with clear cell adenocarcinoma of the cervix: A case report and review of the literature

Abstract

Introduction: Clear cell adenocarcinoma of the cervix (CCAC), a rare and more severe type of gynecological cancer, is especially rare in pediatric patients. Traditionally, surgery following chemotherapy (CT) and radiation therapy is the preferred treatment for CCAC; however, patients have poor 5-year survival rates than other types of cervical cancers.

Patient concerns: A 6-year-old girl with a history of vaginal discharge for 18 months was diagnosed with CCAC by histological examination. Her parents refused the traditional treatment of radical hysterectomy and lymph node dissection because of her young age.

Diagnosis: The patient's tests revealed negative human papilloma virus and negative methylated paired box 1 gene results. The tumor mass histopathology revealed stage IIA1 CCAC that originated from the cervix.

Interventions: Tumor mass excision with preservation of the cervix by electrosurgical biopsy under hysteroscopy was performed. Four cycles of docetaxel and oxaliplatin CT were administered every 3 weeks.

Outcomes: No signs of recurrence were observed in the 28 months after final treatment and diagnosis on magnetic resonance imaging, color ultrasonic imaging, and gynecological examination. Serologic tumor biomarkers were also within normal ranges.

Conclusions: This is the first reported CCAC case in which the primary treatment included electrosurgical biopsy of the polypoid mass under hysteroscopy, followed by CT without traditional treatment: radical surgery with pelvic and/or lymphadenectomy for fertility preservation. This is a new treatment approach for young CCAC patients without the use of surgery.

Figure 1

T2-weighted contrast-enhanced magnetic resonance imaging (MRI) results: preoperative (axial): a cystic lesion with a solid component was detected in the uterine cervix (arrow). An estimated measurement of 11mm × 16mm × 13 mm solid occupation can be seen at the cervix. The tumor mass was arising from the cervix into the vagina without breaking through the serous layer. preoperative (coronal): a highly suspicious solid malignant lesion occupying the tip of the cervix. MRI = magnetic resonance imaging.

Figure 2

Positron emission tomography-computed tomography (PET-CT): preoperative (axial): the whole-body image scan with no other suspicious heterogeneously enhanced masses in the lymph nodes or any other organ. preoperative (coronal): a well-defined heterogeneously enhanced mass (metabolic map) at the tip of the right lateral wall of the vagina. preoperative (coronal): the lower abdomen and the cervix-vaginal area of the CT image. preoperative (coronal): The metabolic map of the same area as the Figure 2C photograph. PET-CT= positron emission tomography-computed tomography.

Figure 3

Under hysteroscopy (GE discovery VCT, GE Healthcare), a solid mass, occupying a position at about 1.5 × 2 cm in the cervix, can be seen.

Figure 4

A large number of different types of cells were seen under the microscope, with bright and nested cytoplasm and with some being hollow or ring shaped.