PMC6345091_01
The cervical punch biopsies showed flat sheets of an epithelioid tumour with minimal pleomorphism, cytoplasmic pigmentation, scattered mitoses (A and B: hematoxylin-eosin staining, 10x, 40x). The tumour was strongly positive for HMB-45 (C), showed weaker patchy positivity for Melan-A (D) and was negative for S100 (E). No stromal component was identified. The final surgical specimen histology from the hysterectomy showed PEComa (large arrow) and mesonephric adenocarcinoma (small arrow) immediately adjacent to each other (short arrows) (F: hematoxylin-eosin staining, 10x).
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However, the low degree of pleomorphism and the low mitotic count favoured PEComa over melanoma (Fig. 1).
Imaging tests of the uterine cervix. (A and B) The ultrasound scanning of the cervix where a 3.4 x 2.1 cm2 hypoechoic mass is demonstrated in the proximal endocervical region with internal colour flow Doppler signals. (C and D) The MRI imaging of a 3 cm endocervical mass with an intermediate signal intensity. Images (E and F) PET-CT scan images of the pelvis where a 4.5 x 2.5 cm2 soft tissue mass is demonstrated which is centred on the uterine cervix with a marked uptake on PET (max SUV 14.8).
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No evidence of metastatic disease or abnormal lymph nodes was shown (Fig. 2).