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(A and B) A large cervical tumor was identified in the T2 sequence of pelvic magnetic resonance imaging, demonstrating no signs of local invasion.
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Pelvic magnetic resonance imaging confirmed the presence of a 4 cm tumor, with no signs of local invasion or distant metastases (Fig. 1A and B).
A local examination of the vagina revealed a large ulcerated and hemorrhagic tumor.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
Dissection of the left ureter and the left iliac vessels from the intraoperative aspect.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
Total radical hysterectomy with bilateral adnexectomy was performed. The lesion was completely mobilised and the vagina was partially sectioned.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
En bloc resection of the left utero-sacrat ligament with the specimen.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
Large adenopathies at the origin of the inferior mesenteric artery.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
The inferior mesenteric artery was completely dissected, with para-aortic lymph node dissection.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
The common iliac artery and its branches were dissected and the lymph nodes were removed.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
Large tumor of the uterine cervix.
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The patient underwent surgery and a total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection was performed (Figs. 2-9).
Histopathological investigations revealed (A) the presence of a neuroendocrine cervical tumor (H&E staining; magnification, x10), (B) intravascular tumor embolus in the inferior region of the image (magnification, x10), (C) and a malignant tumor with high grade mitotic activity (H&E staining; magnification, x40). Immunohistochemistry investigations revealed the expression of (D) synaptophysin (magnification, x20), (E) cytokeratin-7 (magnification, x40), (F) carcinoembryonic antigen (magnification, x40), (G) chromogranin (magnification, x40) and (H) Ki-67 (magnification, x20), and (I) the lack of progesteron receptor expression in tumor cells (top), but the presence of progesteron receptor in the surrounding stroma (magnification, x20). H&E, hematoxylin and eosin.
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Histopathological examination confirmed the pre-operative diagnosis of a large cell NECC, with vascular tumor emboli (Fig. 10A-C). The tumor cells did not express progesteron receptors, which were expressed in the surrounding stroma and cervical glands (Fig. 10D-I).