Cervical Cancer in a Septate Uterus with Double Cervix and Double Vagina: A Case Report and Review of the Literature

Abstract

Septate uterus with duplicate cervices and double vagina is a rare Müllerian duct anomaly mostly found in labor or gynecological examination. We present a case of a 40-year-old asymptomatic parous patient diagnosed with double cervix and complete vaginal septum. She was admitted to hospital due to abnormal histopathology of suspicious cervical squamous papillary carcinoma post-salpingectomy. Her genital malformation was seriously addressed due to the cervical lesion. The diagnosis of cervical cancer in the left cervix and LSIL in the right cervix was made after LEEP conization. She received laparoscopic hysterectomy with salpingectomy and partial vagina wall resection for radical resection of the lesion. We report this case to present irregular findings during colposcopy, hysterectomy, and histopathology.

Keywords: Müllerian duct anomaly; cervical cancer; double vagina; duplicate cervix; septate uterus.

Figure 1

T2 weighted MRI images of the pelvis. No obvious cervical lesion or lymph node enlargement in the pelvic cavity was observed. (A and B) Axial slice demonstrated two uterine cavities and cervical canals with a flat fundus. A septum can be seen in the midline of the uterus which extended to the external cervical ostium (White arrow-septum; black arrow-right cervical canal; grey arrow-left cervical canal). The distance between the endometrium of bilateral cornua uteri (black line) was 3.6 cm and its distance to the uterine fundal serosal layer (white line) was 1.0 cm; (C) Coronal slice showed double cervical canals (White arrow-septum); (D) Sagittal slice through cervix and uterus showed no definite lesion in cervix.

Figure 2

Colposcopic and microscopic view of the exogenous squamous papillary carcinoma at the left cervix. (A) Acetowhite epithelium located at 1–2 o’clock under colposcopy; (B) Negative iodine staining area located at 1–2 o’clock under colposcopy; (C) Several invasive carcinoma nests can be seen in the conization tissue (×100); (D) Keratin pearls can be seen in carcinoma nests (×200); (E) Cervical squamous column junction was normal (×100); (F) Vagina epithelia showed negative excisional margin (×100).