Georgios Gitas: Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany.
Kubilay Ertan: Department of Gynecology and Obstetrics, Leverkusen Municipal Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
Achim Rody: Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany.
Sascha Baum: Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, House 40, 23538, Luebeck, Germany.
Dimitrios Tsolakidis: 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Ibrahim Alkatout: Department of Gynecology and Obstetrics, University Hospitals Schleswig Holstein, Campus Kiel, Arnold-Heller-Strasse 3, House 24, 24105, Kiel, Germany. ibrahim.alkatout@uksh.de.
BACKGROUND: papillary squamotransitional cell carcinoma of the uterine cervix is a rare neoplasm, a subtype of transitional cervical carcinoma that appears to be a variation of squamous cervical carcinoma. It has a disposition toward metastasis at an advanced stage and local recurrence. Owing to the difficulty of illustrating the invasion histologically, misdiagnosis is likely to affect the patient's prognosis. CASE PRESENTATION: We present a case report of an 81-year-old Caucasian patient with squamotransitional cell carcinoma with unusual clinical behavior that was primarily thought to be ovarian cancer. According to the clinical examination and radiologic imaging, the patient had no vaginal bleeding and a normal cervix. Nevertheless, the tumor was already metastasized at the retroperitoneal tissue and at the right ovary. Computed tomography-guided biopsy of the right adnexa gave no further clarification. Although the tumor resembled urothelial cancer, this diagnosis was dismissed because of the results of immunohistochemistry analysis with CK7, CK5, and CK20. Because of the differential diagnosis of ovarian cancer, we decided in favor of an exploratory surgical approach. Hysterectomy with bilateral adnexectomy, extensive retroperitoneal tumor debulking, and infragastric omentectomy was performed by laparotomy. Histopathology revealed a squamotransitional cervical cancer as the primary tumor with a tumor stage of pT3b, pN1 (1/2), V0, RX, G2, corresponding to International Federation of Gynecology and Obstetrics stage IIIB. CONCLUSIONS: As far as we are aware, this is the first report of papillary squamotransitional cell carcinoma of the uterine cervix metastatic to the ovary without vaginal bleeding and with a clinically and radiologically unsuspicious cervix. Physicians should always contemplate papillary squamotransitional cell carcinoma of the uterine cervix in unclear cases with ovarian metastasis, especially if the histology indicates a transitional cancer (CK7 and CK20), before proceeding with treatment. More cases are needed to illuminate the clinical characteristics and categorization of papillary squamotransitional cell carcinoma of the uterine cervix.
