Department of Women's and Children's Health, University of Padua, 35100 Padua, Italy.
Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy.
Viruses. 2021 Feb 16;13(2):307. doi: 10.3390/v13020307.
Cervical cancer is caused by a persistent infection with high-risk types of Papillomaviruses (hrHPV); HPV16 and HPV18 are associated with about 70% of the cases. In the last decades the introduction of a cervical cancer screening has allowed a decrease in cervical cancer incidence and mortality; regular adhesion to the screening procedures, by pap test or HPV test, and colposcopy, according to the international guidelines, prevents cancer development and allows for diagnosis at the early stages. Nowadays, in industrialized countries, it is not common to diagnose this pathology in advanced stages, and this occurrence is frequently associated with patient's unattendance of cervical screening programs. We describe a case of delayed diagnosis of cervical cancer, posed only after the onset of the neurological symptoms caused by leptomeningeal metastases, despite a two-year history of abnormal cytology. The endocervical mass was analyzed by immunohistochemistry, and search and typing of HPV sequences was performed by PCR in the meningeal carcinomatous cells. A poorly differentiated squamous cell carcinoma was diagnosed, and HPV18 sequences were detected. This rapidly fatal case highlights the importance of following the evidence-based recommended protocols and the preventive role of the population-based cervical cancer screening programs.
宫颈癌是由高危型人乳头瘤病毒（HPV）持续性感染引起的；HPV16 和 HPV18 与约 70%的病例有关。在过去的几十年中，宫颈癌筛查的引入使得宫颈癌的发病率和死亡率有所下降；根据国际指南，定期进行巴氏涂片检查或 HPV 检测以及阴道镜检查等筛查程序可以预防癌症的发展，并在早期阶段进行诊断。如今，在工业化国家，晚期诊断这种疾病并不常见，这种情况通常与患者未能参加宫颈癌筛查计划有关。我们描述了一例宫颈癌的延迟诊断病例，尽管存在两年的细胞学异常病史，但仅在出现脑膜转移引起的神经症状后才被诊断出来。通过免疫组织化学分析了宫颈内膜肿块，并通过聚合酶链反应（PCR）在脑膜癌性细胞中搜索和分型 HPV 序列。诊断为低分化鳞状细胞癌，并检测到 HPV18 序列。这例快速致命的病例突出了遵循循证推荐方案的重要性，以及基于人群的宫颈癌筛查计划的预防作用。
