title: Villoglandular adenocarcinoma of the cervix recurrent in an episiotomy scar: a case report in a 32-year-old female.
abstract: Cervical cancer during pregnancy is rare, occurring in approximately 3% of cervical cancer cases. Considerable controversy exists as to the long-term prognosis of patients diagnosed during pregnancy. A 32-year-old female presented with vaginal spotting in April 1998. A prenatal smear in December 1996 revealed atypical glandular cells of undetermined significance. A sterile speculum exam in April 1997 at 31-week gestational age revealed a polyp on the anterior lip of the cervix, pathology consistent with a well-differentiated villoglandular adenocarcinoma. In August 1997, the patient underwent a radical hysterectomy with pelvic/para-aortic lymphadenectomy. In April 2001, she represented with nodular perineal mass in the episiotomy incision. She received preoperative radiotherapy with a near-complete response and remained without disease for >10 months. It appears that a less radical procedure can offer significant therapeutic value. Preoperative radiotherapy proved effective at achieving a near-complete response. The patient underwent a wide local excision of the perineal area with resultant negative margins.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Heron
authors.forename: A
authors.initials: A
authors.lastname: Axtel
authors.forename: K
authors.initials: K
authors.lastname: Gerszten
authors.forename: A
authors.initials: A
authors.lastname: Amortegui
authors.forename: J
authors.initials: J
authors.lastname: Kelley
authors.forename: J
authors.initials: J
authors.lastname: Comerci
authors.forename: R P
authors.initials: RP
authors.lastname: Edwards
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010502:Perineum / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*