A Rare Case of Clear Cell Adenocarcinoma of the Cervix with No Intrauterine Diethylstilbestrol Exposure

Abstract

Cervical cancer is the fourth most common cancer in females. Clear cell adenocarcinoma of the cervix is an uncommon histological variant and is usually seen with intrauterine exposure to diethylstilbestrol. A 28-year-old female with no intrauterine exposure to diethylstilbestrol presented with postcoital bleeding. A pelvic exam revealed a cervical mass. Imaging confirmed the cervical mass and positron emission tomography scan showed an increased uptake in the cervical mass as well as the para-aortic and pelvic lymph nodes. Biopsy showed a clear cell carcinoma of the cervix. She was treated with cisplatin and paclitaxel for eight cycles and concurrent radiation therapy. She had a complete response to therapy and has been in complete remission nine months from the end of therapy. There are no clear guidelines for the treatment of clear cell carcinoma with current therapy based on the treatment of squamous and non-clear cell adenocarcinoma. Cisplatin and paclitaxel could be an option, given the successful treatment of the patient in our case.

Keywords: cervical cancer; cervical clear cell carcinoma; cisplatin; clear cell adenocarcinoma of the cervix; clear cell cancer; diethylstilbestrol; paclitaxel.

Figure 1. Biopsy of the cervical mass showing large neoplastic cells with ovoid nuclei and clear cytoplasm consistent with clear cell carcinoma

Figure 2. Pelvic MRI before treatment, showing the cervical mass projecting into the vagina

Figure 3. Positron emission tomography scan showed increased metabolic activity in cells on the cervical surface

Figure 4. Pelvic MRI after treatment showing resolution of the cervical mass

Figure 5. PET scan after treatment showing no evidence of local or distant metastatic disease