Superficial Spreading, Microinvasive CIN 3 of Cervix: Report of an Unusual Pattern of Endometrial Involvement

Abstract

Microinvasive squamous cell carcinoma (SCC) of the cervix is labeled by the lower anogenital squamous terminology as superficial invasive squamous cell carcinoma (SISCCA). This currently conforms to the T1a1/FIGO IA1 stage, which is defined with a stromal invasion of less than 3 mm in depth (Darragh et al. in Arch Pathol Lab Med 136(10):1266-1297, 2012). Under rare circumstances, these carcinomas can spread laterally to involve the endometrium, which increases the tumor volume and is a significant predictor of outcome. We present a case report of a 60-year-old post-menopausal woman who presented with persistent bleeding and absence of an overt cervical mass on magnetic resonance imaging. She underwent a Wertheim's hysterectomy, and on pathological examination, the cervix revealed a diffuse CIN 3 (Cervical Intraepithelial Neoplasia) with focal microinvasion. In addition, there was extensive superficial spread to the entire endometrium along with focal invasion and lymphovascular space invasion. This presentation is extremely rare, with less than 50 cases reported worldwide (Bagde et al. in J Fam Med Prim Care 10(9):3505, 2021).

Keywords: CIN 3 cervix; CIN 3 endometrium; Microinvasive SCC; Superficial spreading SCC.

Fig. 1

MRI of pelvis. A Sagittal, B Axial T2 weighted images show distended endometrial cavity (black arrows). No overt cervical mass is seen. C Immediate postoperative image showing uterus and cervix. D Gross image after formalin fixation showing irregular appearance of endometrial cavity. No overt growth was identified in the cervix

Fig. 2

Histopathological features from the uterus. A Endometrial lining replaced by squamous neoplastic cells with involvement of endometrial glands (hematoxylin and eosin, × 100). B Lymphovascular space invasion by atypical squamous cells (hematoxylin and eosin, × 400). C p16 immunostain showing block-like positivity in the endometrium (inset)