The Importance Of Re-examination With Deep Biopsies In Diagnosing Cervical Malignancies Despite Multiple Negative Pathology Reports: A Case Report | 54547
Journal of Cancer Science & Therapy
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Clinical symptoms of female genital tract lymphoma are often non-specific and mimic other more common gynecological
malignancies. Diagnosis can only be confirmed by histology. A 48-year-old multiparous woman was referred to the
gynecology clinic because of enlarged myomatous uterus and persistent heavy vaginal bleeding. She underwent a subtotal
hysterectomy and unilateral salpingo-oophorectomy in a Hospital in Yazd (Iran). Intraoperatively severe bleeding occurred
and dense cervical adhesions to peripheral tissues were found. Pathology report indicated benign leiomyoma. After a few
months, an abdomino-pelvic CT scan was performed because of flank pain that revealed bilateral hydronephrosis. The
patient was referred to the Gynecology Oncology clinic of Bahman hospital in Tehran. Pelvic and rectovaginal exam and
colposcopy were performed. Biopsy report was negative, after which mycobacterium tuberculosis test showed negative results.
Under general anesthesia, multiple deep cervical biopsies revealed no malignancy again. The slides were reviewed by another
“referral” pathologist who reported a typical lymphoid infiltration, consistent with malignant lympho-proliferative disorder in
parametrial biopsies. Immunohistochemistry confirmed the diagnosis. The stony appearance of the cervix and a concomitant
frozen pelvis strongly supported the diagnosis of cervical malignancy. The role of gynecological examination in the diagnosis
of genital cancer is essential. When frozen pelvis and a fixed stony cervix are present, it is necessary to perform multiple
deep biopsies in spite of previous negative pathologies. Review of the slides by qualified pathologists can help achieve an
accurate diagnosis. Despite histopathological errors, lymphoma should always be considered by pathologists, particularly in
these unusual cases.
Azadeh Memarian has completed his Expertise in forensics from Iran University of Medical Sciences, Tehran, Iran. She is Assistant Professor of Forensic Medicine. She has published more than 25 papers in journals and has been serving as an Editorial Board Member of Tehran University Medical Journal.