Cervical Cancer in Pregnancy

3 Cases, 3 Different Approaches

Filipa Ribeiro, MD; Lúcia Correia, MD; Tereza Paula, MD; Isabel Santana, MD; Luís Vieira Pinto, MD; Jorge Borrego, MD; Ana Francisca Jorge, MD

Disclosures

J Low Genit Tract Dis. 2013;17(1):66-70. 

In This Article

Case Report

In our institution, 3 early-stage cervical neoplasias were identified in the last 5 years.

Case 1

A 29-year-old African woman, gravida 3 para 1, was referred at 16 weeks of gestation with a polypoid hemorrhagic cervical lesion, with low-grade squamous intraepithelial lesion on cervical cytology. Gynecologic pelvic examination showed sessile polypoid cervical tumor, with approximately 2 cm, going into the endocervix, without parametrial or vaginal involvement. Colposcopic evaluation revealed a suspicious high-grade disease, and excisional biopsy was performed revealing a poorly differentiated, invasive squamous cell carcinoma. A pelvic magnetic resonance image (MRI) showed a cervical lesion of 2.5 cm in diameter, without parametrial invasion, compatible with the clinical cervical carcinoma FIGO stage IB1.

Because the patient chose to terminate the pregnancy, a radical hysterectomy with the fetus in situ, with ovarian preservation and pelvic lymphadenectomy, was performed. Histological examination revealed a cervical invasive squamous cell carcinoma, nonkeratoid of 1.3 cm; margins of 9 mm, free of disease; without parametrial invasion; and 27 negative pelvic lymph nodes. No further adjuvant therapy was proposed. At 2 years of follow-up, a pelvic lymphocele was drained, which was negative in cultural and cytological evaluation. At 5 years of follow-up, the patient is free of disease.

Case 2

A 33-year-old white primigravida was referred at 16 weeks of gestation with a cervical lesion and atypical squamous cell of undetermined significance on Pap smear. The patient did not have any abnormal bleeding, discharge, or pain. Pelvic examination revealed a 1.5-cm cervical mass on the posterior lip of the cervix. On rectovaginal examination, the parametria and posterior fornix seemed to be free of disease. Biopsy revealed poorly differentiated adenosquamous cervical carcinoma. An MRI study of the patient's abdomen and pelvis showed a 2.6-cm lesion, confined to the cervix, without parametrial invasion, hydronephrosis, or lymphadenopathy. The patient was diagnosed with cervical carcinoma FIGO stage IB1.

Because the patient strongly desired to continue the pregnancy and given the size of the tumor, after complete and meticulous counseling, a follow-up plan was established. Trimestral disease stage evaluation with pelvic MRI and high-risk obstetric care were performed.

The lesion bled and grew in the third trimester, with MRI scan at 31 weeks of gestation revealing a 3.2-cm exophytic cervical mass, with no parametrial invasion. At 34 weeks of gestation, an elective cesarean delivery of a male newborn, 2,346 g, with Apgar index of 8/9, was performed. Radical hysterectomy with ovarian preservation (strongly desired by the patient) and pelvic lymphadenectomy followed 3 weeks later. Histological report revealed a 3-cm cervical squamous cell and undifferentiated carcinoma; margins of 10 mm, free of disease; negative parametria; and 16 negative pelvic lymph nodes. She had a vaginal metastasis at 5 months of follow-up and went to chemoradiotherapy. At 2.5 years of follow-up, patient is without evidence of disease and the child has a normal neurodevelopment.

Case 3

A 34-year-old white gravid was diagnosed with a suspicious lesion of the cervix. She had no previous Pap smear results. On pelvic examination, the patient was found to have a 2.5-cm exophytic cervical mass, without parametrial or vaginal involvement. Cytology and cervical biopsy were performed, which revealed cervical invasive squamous cell carcinoma. Thoracic, abdominal, and pelvic imaging evaluation showed a lesion compatible with the clinical cervical carcinoma FIGO stage IB1.

Because the patient explicitly expressed the wish to preserve the pregnancy, an elective radical cesarean hysterectomy with ovarian preservation and pelvic lymphadenectomy were performed at 34 weeks of gestation, after antenatal corticosteroids for pulmonary maturation were administered. A female newborn was delivered, with 2,935 g and Apgar index of 9/10. Histological evaluation of surgical specimen revealed a 2.5-cm invasive cervical squamous cell, large cells and keratinized; margins of 10 mm, free of disease; negative parametria and 10 negative pelvic lymph nodes. This patient is now under 6 months of follow-up. No adjuvant therapy was needed. The baby at 6 months of follow-up has a normal neurodevelopment according to age.

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