A case of gastric-type mucinous adenocarcinoma of the uterine cervix detected by cervical cancer screening

Background : Gastric-type adenocarcinoma (GAS) is a newly described variant of mucinous adenocarcinoma of the uterine cervix, which typically arises away from the squamocolumnar junction (SCJ). It is typically well differentiated and is not associated with human papillomavirus infection. Case : A 59-year-old woman was suspected to have adenocarcinoma by cervical cancer screening. She had undergone routine cytological screening without positive results for more than 10 years. Colposcopy was unsatisfactory and microscopic examination of endocervical curettage specimens failed to confirm the diagnosis. Imaging studies, including MRI and PET-CT suggested an invasive lesion at the internal os, based on which we performed nerve-sparing radical hysterectomy without cone biopsy. The hysterectomy specimen revealed GAS with and extension to the lower uterine segment. The pathological stage was pT1b2, pN0. Adjuvant chemotherapy was administered and the patient remains alive without recurrence at 24 months after the treatment. Conclusion : In this particular case, change of screening device from cotton swab to cervical brush contributed to the detection of organ-confined GAS, which is frequently found at an advanced stage, and shows aggressive clinical behavior and a poor prognosis.