PMC4701796_01
The patient's pretreatment computed tomography (CT) scan. The top two images show the primary cervical mass. The bottom two images demonstrate the left external iliac lymphadenopathy.
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A computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast was obtained and showed a 5.8 x 5.7-cm enhancing mass in the cervix with involvement of the left parametrium and left ureter, causing mild hydronephrosis, with 2 left external iliac pathologic lymph nodes (Fig. 1).
(A) This histological section of the cervical tumor shows nests of infiltrating poorly-differentiated carcinoma cells with pleomorphic nuclei and cleared-out cytoplasm. Abundant mitoses and individual cell tumor necrosis is also noted. (B) The tumors cells were strongly and diffusely positive for the surrogate HPV marker, p16INK4a, as demonstrated by nuclear and cytoplasmic staining.
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A papanicolaou test was also performed, revealing HPV 16 positivity, and, once discharged from the emergency department, an ectocervical biopsy was performed showing moderately differentiated invasive squamous cell carcinoma of the cervix (Fig. 2).
These images demonstrate the positron emission tomography (PET) positivity of the umbilical mass in the anterior abdominal wall. The left one is the axial slice and the right one is the sagittal reconstruction.
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The radiologist noted it corresponded to an area of umbilical thickening measuring 2 cm (Fig. 3). They noted it may represent granulation tissue, previous infection, or even a tumor implant, though the latter seemed less likely.
(A) A representative histological section of the umbilical mass shows nests of carcinoma cells embedded in a dense fibrous stroma. These cells are morphologically identical to the cells of the primary cervical tumor (Fig. 2A). (B) Immunohistochemical studies using p63 demonstrate that the malignant cells are squamous in origin. (C) A positive p16ink4a immunostain further reveals that the malignant cells originate from the cervical primary.
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A 3-cm nodule under the umbilicus involving the fascia was removed, and pathology revealed metastatic carcinoma consistent with poorly differentiated squamous carcinoma (Fig. 4).