Hsu Yi-Ting, Law Kim-Seng
Department of Obstetrics and Gynecology, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan.
Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
Heliyon. 2022 Aug 17;8(8):e10268. doi: 10.1016/j.heliyon.2022.e10268. eCollection 2022 Aug.
There are many different variants of squamous cell carcinoma (SCC), and verrucous carcinoma (VC) is a rare and highly differentiated SCC. Due to its preference of local invasion, regional lymphatic involvement rarely occurs. VC is difficult to diagnose using conventional pap smear or cervical punch biopsy, in which adequate stroma including bulbous rete pegs is required for a definitive diagnosis. Surgical management is recommended as the first-line treatment with radiotherapy forbidden due to the risk of anaplastic transformation.
We presented a 59-year-old Taiwanese female who had postmenopausal bleeding for three months with two consecutive normal pap smear and biopsy at other hospital. Pelvic examination showed a necrotic fungating cervical mass with upper 1/3 vaginal involvement. Colposcopic guided cervical biopsy and fractional dilatation and curettage revealed verrucous hyperplasia (VH) with negative high-risk HPV typing. Pelvic 3T magnetic resonance imaging (MRI) was arranged, and a 3.7 × 3.6 × 4.0 cm necrotic mass at the cervix with an enlarged left pelvic lymph node was found. Positron emission tomography with computed tomography (PET/CT) demonstrated avid uptake at the cervix and left pelvic lymph node. Surgical intervention was performed due to highly suspicious of cervical verrucous carcinoma with positive pelvic lymph node. The final pathologic report was a well-differentiated verrucous carcinoma, IIA2 by International Federation of Gynecology and Obstetrics (FIGO) classification.
VC is difficult to diagnose preoperatively, and surgical excision is recommended as the first-line treatment.
鳞状细胞癌（SCC）有许多不同变体，疣状癌（VC）是一种罕见且高分化的SCC。由于其偏好局部浸润，很少发生区域淋巴结受累。使用传统巴氏涂片或宫颈穿刺活检难以诊断VC，明确诊断需要足够的间质，包括球茎状 rete 钉。建议手术治疗作为一线治疗，因有间变转化风险而禁止放疗。
我们报告了一名59岁台湾女性，绝经后出血3个月，在其他医院连续两次巴氏涂片和活检结果正常。盆腔检查发现宫颈有坏死性蕈状肿物，累及阴道上1/3。阴道镜引导下宫颈活检及分段刮宫显示疣状增生（VH），高危型人乳头瘤病毒（HPV）分型为阴性。安排了盆腔3T磁共振成像（MRI），发现宫颈有一个3.7×3.6×4.0 cm的坏死肿物，左侧盆腔淋巴结肿大。正电子发射断层扫描计算机断层显像（PET/CT）显示宫颈和左侧盆腔淋巴结有高摄取。由于高度怀疑宫颈疣状癌伴盆腔淋巴结阳性，进行了手术干预。最终病理报告为高分化疣状癌，根据国际妇产科联盟（FIGO）分类为IIA2期。
VC术前难以诊断，建议手术切除作为一线治疗。
