Xie Chaoping, Liu Hongcen, Huang Daxia, Zhao Ganmei, Qiu Min, Liu Yong, Mao Dongwei
Department of Gynecology, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
Department of Gynecology, Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China.
Front Oncol. 2025 Aug 27;15:1647366. doi: 10.3389/fonc.2025.1647366. eCollection 2025.
Early-stage cervical cancer, which is often asymptomatic, presents considerable diagnostic difficulties when accompanied by vaginal adhesions that conceal malignant lesions. In this report, we describe an exceptionally rare case of cervical cancer complicated by extensive pyometra and pyocolpos, highlighting key diagnostic challenges and evidence-based treatment approaches.
A 61-year-old postmenopausal woman presented with abdominal distension and pain. Initial imaging, including ultrasound and CT, suggested an ovarian tumor. However, contrast-enhanced MRI identified a pyometra and pyocolpos complex, with malignant cytology detected in the drained fluid. Diagnostic exploratory laparotomy was necessitated due to extensive pyometra and pyocolpos precluding adequate diagnostic biopsy, with final histopathological confirmation of stage IIA1 squamous cell carcinoma of the cervix (FIGO 2018 criteria). Following the cervical cancer diagnosis, the patient underwent radical hysterectomy with bilateral salpingo-oophorectomy in late May 202, and received adjuvant radiotherapy post-discharge as further treatment.
The coexistence of cervical cancer complicated by extensive pyometra and pyocolpos is a rare clinical condition that requires a comprehensive multidisciplinary diagnostic approach. For such complex presentations, a tripartite protocol-combining imaging continuity assessment, post-drainage cytomorphologic analysis, and histopathologic verification-is essential to circumvent diagnostic delays and sampling errors.
①Postmenopausal pyometra cannot be excluded as a complication of gynecologic malignancies. High-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma antigen (SCC) can directly extend proximally into the uterus. The most common clinical manifestations include pyometra and cervical stenosis. Emphasis should be placed on early detection and prevention of this condition. ②Combined human papillomavirus (HPV) testing and ThinPrep cytologic test (TCT) screening improve the detection rate of cervical lesions. However, in this patient, vaginal wall adhesions prevented cervical exposure, resulting in a false-negative finding and increasing the risk of missed diagnosis. ③Elevated serum levels of squamous cell carcinoma antigen (SCC-Ag) warrant heightened clinical vigilance. As a first-line serum biomarker for cervical cancer screening, SCC-Ag elevation may precede the onset of other clinical manifestations in affected patients. ④For cervical carcinomas with limited tumor size (maximal diameter <2 cm), a multimodal diagnostic integration incorporating serum tumor markers (SCC-Ag, CA125), advanced contrast-enhanced imaging (CT/MRI), and diagnostic surgical exploration may be considered. ⑤For early-stage cervical cancer patients complicated by uterovaginal abscess, a staged treatment approach should be adopted. And it's also essential to balance the priorities of infection control and antitumor therapy.
早期宫颈癌通常无症状，当伴有隐匿恶性病变的阴道粘连时，诊断颇具难度。在本报告中，我们描述了一例极为罕见的宫颈癌合并广泛性积脓和阴道积脓病例，突出了关键的诊断挑战及循证治疗方法。
一名61岁绝经后女性因腹胀和腹痛就诊。包括超声和CT在内的初始影像学检查提示卵巢肿瘤。然而，增强磁共振成像（MRI）发现了积脓和阴道积脓复合体，引流液中检测到恶性细胞学特征。由于广泛性积脓和阴道积脓妨碍了充分的诊断性活检，故需进行诊断性剖腹探查术，最终组织病理学确诊为宫颈IIA1期鳞状细胞癌（采用国际妇产科联盟（FIGO）2018年标准）。确诊宫颈癌后，患者于202年5月下旬接受了根治性子宫切除术及双侧输卵管卵巢切除术，并在出院后接受辅助放疗作为进一步治疗。
宫颈癌合并广泛性积脓和阴道积脓是一种罕见的临床情况，需要综合多学科的诊断方法。对于此类复杂表现，结合影像学连续性评估、引流后细胞形态学分析和组织病理学验证的三方方案对于避免诊断延迟和取样误差至关重要。
①绝经后积脓不能排除为妇科恶性肿瘤的并发症。高级别鳞状上皮内病变（HSIL）和鳞状细胞癌抗原（SCC）可直接向近端延伸至子宫。最常见的临床表现包括积脓和宫颈狭窄。应重视对这种情况的早期发现和预防。②联合人乳头瘤病毒（HPV）检测和薄层液基细胞学检测（TCT）筛查可提高宫颈病变的检出率。然而，在该患者中，阴道壁粘连妨碍了宫颈暴露，导致假阴性结果并增加漏诊风险。③血清鳞状细胞癌抗原（SCC-Ag）水平升高需提高临床警惕。作为宫颈癌筛查的一线血清生物标志物，SCC-Ag升高可能先于受影响患者出现其他临床表现。④对于肿瘤大小有限（最大直径<2 cm）的宫颈癌，可考虑采用结合血清肿瘤标志物（SCC-Ag、CA125）、高级增强成像（CT/MRI）和诊断性手术探查的多模式诊断整合方法。⑤对于合并子宫阴道脓肿的早期宫颈癌患者，应采用分期治疗方法。平衡感染控制和抗肿瘤治疗的优先事项也至关重要。
