Local and Metastatic Relapses in a Young Woman with Papillary Squamous Cell Carcinoma of the Uterine Cervix

Abstract

Papillary squamous cell carcinoma (PSCC) is a rare histological type of cervical carcinoma whose biological behavior has not been fully established. A 33-year-old woman with an exophytic cervical mass underwent radical hysterectomy and bilateral pelvic lymph node dissection. Histological examination of the tumor revealed numerous papillary fronds lined by atypical stratified squamous cells, resembling high-grade squamous intraepithelial lesions or urothelium. She was diagnosed with stage IB1 PSCC. Three months postoperatively, a 5.7 cm vaginal stump mass was detected. She received chemoradiotherapy, which helped her achieve a complete response. However, nine months postoperatively, she developed pelvic lymph node metastases. We present a rare case of recurrent cervical PSCC in a young woman. PSCC of the uterine cervix can recur rapidly within just a few months and become aggressive, as in the present case.

Keywords: cervix; metastasis; papillary squamous cell carcinoma; recurrence.

Figure 1

Imaging findings of a 33-year-old woman with a history of abnormal cervicovaginal cytology and high-risk human papillomavirus infection. Preoperative sagittal and axial magnetic resonance imaging (MRI) reveal an exophytic cervical mass (blue arrowheads) that seem to protrude into the vaginal lumen. The parametrium, lymph node, and adnexa are unremarkable. Positron emission tomography (PET) reveal a hypermetabolic lesion in the right lateral aspect of the uterine cervix (blue arrowhead), which is also shown in the maximum intensity projection image. She underwent radical hysterectomy with bilateral pelvic lymph node dissection and was diagnosed with early-stage cervical squamous cell carcinoma. Three months postoperatively, follow-up MRI and PET detect a recurrent tumor on the anterior wall of the vaginal stump (green arrowheads). She received chemoradiation therapy and achieved complete remission. However, pelvic lymph node metastases are developed nine months postoperatively (yellow arrowheads). Axial MRI and PET show two enlarged and hypermetabolic lymph nodes in the right obturator area.

Figure 2

Gross and microscopic findings. Gross examination reveal an exophytic tumor (green arrowheads) arising from the right lateral aspect of the uterine cervix and protruding into the vaginal lumen. The cut surface show a papillary-appearing tumor (green arrowhead) with unapparent stromal invasion. On scanning magnification, the tumor is characterized by a predominantly exophytic growth towards the vaginal lumen. Numerous, variably-sized papillary fronds are richly vascularized and lined by stratified squamous epithelium. Finger-like protrusions or leaf-like structures and arborescent fibrovascular cores are frequently observed. The tumor papillae are either thin with a delicate fibrovascular core or broad with occasional vascular congestion and lymphoplasmacytic infiltrates. These histological features are consistent with papillary squamous cell carcinoma of the uterine cervix.

Figure 3

Microscopic findings and immunostaining results. A few microscopic foci (yellow arrowheads) of superficial stromal invasion are noted. The invasion depth measures 1 mm at the deepest point. The tumor cells demonstrate moderate-to-severe nuclear pleomorphism accompanied by occasional atypical mitotic figures (green circles). Mitotic activity is brisk (blue circles). Immunohistochemically, the tumor exhibits block p16 positivity and diffuse and strong p63 expression, supporting the diagnosis of human papillomavirus-associated squamous cell carcinoma. Cytokeratin 7 (CK7) is uniformly and intensely positive for the tumor cells, whereas CK20 is completely negative, indicating this tumor is a variant of squamous cell carcinoma.