|Year : 2016 | Volume
| Issue : 3 | Page : 241-243
Rare case of cervical cancer arising in bicornuate uterus
Amitabh Jena1, Rashmi Patnayak2
1 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
|Date of Web Publication||10-Oct-2016|
Department of Surgical Oncology, Sri Venkateswara Institute Of Medical Sciences, Tirupati, Andhra Pradesh - 517 507
Source of Support: None, Conflict of Interest: None
Very few case reports are available in the literature regarding cervical cancer arising in bicornuate uterus. A 43-year-old Indian woman presented with complaint of bleeding per vaginum and white discharge for last 1 year. On examination, there was an ulceroproliferative lesion in the cervical region with free fornices. Per rectal examination did not reveal any parametrial involvement. Magnetic resonance imaging of the pelvis showed bicornuate uterus with growth in the cervix. Clinically, the patient was diagnosed as carcinoma cervix stage IB/IIA. Histopathology of the cervical biopsy was reported as moderately differentiated squamous cell carcinoma. The patient underwent radical hysterectomy, and the postoperative period was uneventful. Then she was referred to radiotherapy. After 1 month follow-up, she was healthy.
Keywords: Bicornuate uterus, carcinoma cervix, cervix
|How to cite this article:|
Jena A, Patnayak R. Rare case of cervical cancer arising in bicornuate uterus. J NTR Univ Health Sci 2016;5:241-3
| Introduction|| |
Müllerian duct anomalies resulting from nondevelopment or nonfusion of the Müllerian ducts are rare. The true prevalence is unknown but they are estimated to occur in 0.1–0.5% of women. Bicornuate or didelphys uterus results from complete or partial absence of Müllerian duct fusion and/or canalization. Apart from infertility, individuals with Müllerian duct anomalies present with primary amenorrhoea, retrograde menstruation, endometriosis, hematocolpos, and hematosalpinx. However, increased mortality or development of gynecological cancers are not associated with the presence of Müllerian duct anomalies., Although cervical cancer is the most common form of cancer among Indian females, very few reports are available in the literature regarding cervical cancer arising in bicornuate uterus.,,
| Case History|| |
A 43-year-old Indian woman presented with complaints of bleeding per vaginum and white discharge for last 1 year. On examination, there was an ulceroproliferative lesion in the cervical region with free fornices. Per rectal examination revealed free parametria.
Magnetic resonance imaging (MRI) of the pelvis showed bicornuate uterus with growth in the cervix.
Clinically, the patient was diagnosed as carcinoma cervix stage IB/IIA. Histopathology of the cervical biopsy was reported as moderately differentiated squamous cell carcinoma. The patient underwent radical hysterectomy, and the postoperative period was uneventful [Figure 1] and [Figure 2]. Then she was referred to radiotherapy. After 1 month of follow-up, she was healthy.
|Figure 1: Intraoperative picture of the pelvis showing bicornuate uterus|
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|Figure 2: Hysterectomy specimen of bicornuate uterus with its appendages|
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| Discussion|| |
Cervical cancer is one of the most common female cancers worldwide., The peak incidence of cervical cancer is encountered in the third and fourth decades. Squamous cell carcinoma is the most common histological subtype.
Müllerian ducts anomalies are rare. Individuals with Müllerian duct anomalies commonly present with infertility.,
According to the American Fertility Society (AFS) Scheme (1988), congenital anatomical anomalies of Müllerian ducts are most commonly categorized as follows:
Class I: Hypoplasia/agenesis includes uterine and/or cervical agenesis or hypoplasia.
Class II: Unicornuate uterus caused by arrest of development of one Müllerian duct. There may be a rudimentary horn with or without uterine cavity.
Class III: Didelphy uterus resulting from complete nonunion of both Müllerian ducts. There are two uterine cavities and cervices. This anomaly is commonly associated with transverse vaginal septa.
Class IV: Bicornuate uterus caused by partial nonunion of Müllerian ducts at the level of fundus with resultant myometrium septum extending to the internal os (bicornuate unicollis) or external os (bicornuate bicollis).
Class V: Septate uterus resulting from the failure of resorption of the septum between two Müllerian ducts.
Class VI: Arcuate uterus is a uterus with a single uterine cavity and convex or flat fundus.
Class VII: Diethylstilbestrol-related anomaly.
There have been reports published on cases of coexistence of uterocervical abnormalities and carcinoma.,, However, evidence to suggest a definite link between congenital malformation of the female genital tract and the development of neoplasia is lacking.
As such a condition is rarely seen, standard radical radiation treatment plan cannot be readily applied. Moreover, brachy therapy treatment can be challenging owing to the anatomical anomaly.
We conclude that cervical carcinoma arising in bicornuate uterus is indeed a rarity.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Loo HW, Locks SM. Squamous cell carcinoma of the cervix: Report of an unusual case of bicornuate bicollis uterus treated with bilateral intracavity brachytherapy. Br J Radiol 2010;83:e143-6.
Lee CD, Churn M, Haddad N, Davies-Humphries J, Kingston RK, Jones B. Bilateral radical radiotherapy in a patient with uterus didelphys. Br J Radiol 2000;73:553-6.
Shulman LP. Müllerian anomalies. Clin Obstet Gynecol 2008;51:214-22.
Nandakumar A, Anantha N, Venugopal TC. Incidence, mortality and survival in cancer of the cervix in Bangalore, India. Br J Cancer 1995;71:1348-52.
Troiano RN, McCarthy SM. Mullerian duct anomalies: Imaging and clinical issues. Radiology 2004;233:19-34.
The American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 1988;49:944-55.
Fox S, Mones JM, Kronstadt R, Saldana MJ. Bilateral and synchronous squamous cell carcinoma of cervix in a patient with uterine didelphys. Obstet Gynecol 1986;67:76s-79s.
[Figure 1], [Figure 2]