Stage IA1 HPV-associated cervical squamous cell carcinoma metastasizing to ovary by special pathway: a case report and literature review

J Ovarian Res. 2022 Feb 3;15(1):21. doi: 10.1186/s13048-022-00949-7.

Abstract

Background: As the leading cancer of the female reproductive tract, it is not uncommon for human papilloma virus (HPV)-associated cervical squamous cell carcinoma (HPV-CSCC) to metastasize to pelvic organs and lymph nodes in advanced stages. However, herein, we present a rare case in which superficial invasive HPV-CSCC metastasized to the unilateral ovary as a large mass by spreading directly through the endometrium and fallopian tubes and lymph-vascular space invasion. The case is so unexpected that the misdiagnosis most likely could be proceeded as a primary ovarian cancer.

Case presentation: A 58-year-old postmenopausal woman presented vaginal bleeding for more than 4 months, never received hormonal treatment and had no family history of malignant diseases. Routine ultrasound revealed a 12 × 10 × 10 cm right ovarian mass. Intraoperative frozen section was diagnosed as a borderline Brenner tumour with local highly suspected invasive carcinoma. Accordingly, omentectomy surgery then occurred. Unbelievably, by observation under a microscope, immunohistochemistrial staining, and HPV RNA scope, we found that the carcinoma originated from the uterine cervix. In the uterine cervix, stage IA1 superficial invasive squamous carcinoma was found, and the carcinoma directly spread to the endometrium and bilateral fallopian tube, was planted into the right ovary and eventually grew as a large mass. Moreover, lymph-vascular space invasion (LVSI) was also discovered. To date, the patient has been given 6 cycles of chemotherapy and has experienced no recurrence.

Conclusions: The diagnosis of superficial invasive cervical squamous cell carcinoma metastasizing to the ovary is very challenging for pathological doctors, especially in intraoperative consultations.

Keywords: Case report; Ovarian metastasis; Superficial cervical squamous cell carcinoma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Carcinoma, Squamous Cell* / drug therapy
  • Carcinoma, Squamous Cell* / etiology
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / virology
  • Cervix Uteri / pathology
  • Cervix Uteri / virology
  • Endometrium / pathology
  • Endometrium / virology
  • Fallopian Tubes / pathology
  • Fallopian Tubes / virology
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Ovarian Neoplasms* / drug therapy
  • Ovarian Neoplasms* / pathology
  • Ovarian Neoplasms* / secondary
  • Ovarian Neoplasms* / virology
  • Ovary / pathology
  • Ovary / virology
  • Papillomaviridae
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / drug therapy
  • Papillomavirus Infections* / pathology
  • Papillomavirus Infections* / virology
  • RNA, Viral / analysis
  • Uterine Cervical Neoplasms* / drug therapy
  • Uterine Cervical Neoplasms* / etiology
  • Uterine Cervical Neoplasms* / pathology
  • Uterine Cervical Neoplasms* / virology

Substances

  • RNA, Viral