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STAGE I CERVICAL CANCER WITH MISSED EARLY PREGNANCY

PRAKASH PATIL*, NITEEN TAPURIA*, SHAILESH SHRIKHANDE*,ANITA SHAH**, GIRISH MUZUMDAR**, CHAUDHARY***
*Department of Oncosurgery; **Department of Histopathology; ***Department of Ultrasonography, Bombay Hospital Institute of Medical Sciences, Mumbai, India.

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A rare case of cervical cancer with missed early pregnancy is discussed being it’s rarity.

INTRODUCTION

The incidence of pregnancy associated with invasive carcinoma of cervix ranges between 0.5% and 5% and incidence of invasive cancer during pregnancy is 0.02% to 0.9%. Reports of maternal cancer being transmitted to the foetus are rare primarily due to the placental barrier for neoplastic transmission. We report a case of carcinoma cervix (stage Ib) that underwent a radical hysterectomy, where direct infiltration of products of conception by malignant cells came as a histological surprise.

CASE REPORT

A 42 year old African muslim lady with a completed family of three daughters, presented with history of bleeding per vagina of a few months duration. Clinical evaluation revealed cervical cancer in stage I. Biopsy reported a squamous cell carcinoma. Ultrasonography of pelvis revealed a bulky uterus without any pelvic lymphadenopathy. There was no evidence of pregnancy. A radical hysterectomy was performed. The patient had a smooth, uneventful post-operative recovery. The histopathology report revealed invasive squamous cell carcinoma of cervix (stage Ib) with invasion of products of conception in contiguity in the uterine fundus. The pelvic lymph nodes were negative for metastasis.

DISCUSSION

The cancers most commonly seen in pregnant women in decreasing order of frequency are can cers of the breast, uterine cervix, thyroid, ovary, lymphomas and colon.[1] Approximately 3% of all carcinomas of the cervix are diagnosed in pregnant women.[2] Pregnancy appears to have no influence on the development or natural history of uterine cervical malignancies.[3] This case had three distinctive features which merit discussion.

This lady hails from a community where cervical cancer is rare due to religious practice of circumcision at birth in their male counterparts.

Secondly, the pregnancy was missed clinically as well as on ultrasonography because it was in a very early stage. However, disproportional excessive bleeding per vaginum and increased pelvic vascularity detected intraoperatively did hint towards a possibility of pregnancy. In this case, it must be pointed out that chorionic villi were invaded by squamous cell carcinoma in contiguity (Fig. 1). Lastly, it is rare for cancer, even in ad vanced stages, to invade products of conception. Reports of maternal cancer being transmitted to the foetus are rare in the medical literature. The malignancies reported to be associated with metastasis from maternal tumour to the foetus are malignant melanoma (the most common) followed by breast cancer and lymphomas. The mother invariably has disseminated disease in these situations. Thirty-five cases have been reported in the published literature in which metastasis to the placenta or foetus have occurred.[4]

Fig 1: Showing chorionic villi invaded by squamous cell carcinoma.

In support of our hypothesis that placenta is a barrier to neoplastic transmission, is a report of five cases of primary foetal cancer (three neoblastomas, one melanoma and one leukaemia) without dissemination to the mother.5 Therefore we believe ours is likely to be the first ever case report of an early cervical cancer (stage I) invading the fundus directly in contiguity, thus breaking the placental barrier.

REFERENCES

1. Haas JF. Pregnancy in association with a newly diagnosed cancer. A population based epidemiologic assessment. In J Cancer 1984; 34 : 229-35.

2. Gilotra PM, Lee FY, Krupp PJ, Batson HW, Collins JH. Carcinoma in situ of the cervix uteri in pregnancy. Surg Gynecol Obstet 1976; 142 : 396-8.

3. Smith EB. Principles of medical therapy in pregnancy. Gleider N (ed). Plenum publishing. New York. 1985; 1112.

4. Rothman LA, Cohen CJ, Astarloa J. Placental and fetal involvement by maternal malignancy : a report of rectal carcinoma and review of the literature. Am J Obstet Gynecol 1973; 116 : 1023-34.

5..Potter JF, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 : 380-8.

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