title: Papillary-serous adenocarcinoma of the uterine cervix during tamoxifen therapy after bilateral breast cancer.
abstract: BACKGROUND
  Papillary-serous adenocarcinoma (PSCC) is a very rare subtype of cervical cancer. To our knowledge, this is the first report on PSCC of the uterine cervix following bilateral breast cancer.
  
  
  METHODS
  A 61-year-old Caucasian woman underwent conserving surgery of both breasts at the age of 57 years, because of bilateral invasive ductal carcinoma. Radiation and tamoxifen treatment followed. Routine surveillance examinations, including pelvic examination, Papanicolaou (Pap) smear, and transvaginal ultrasound, were uneventful. Recently, a small contact-bleeding mass of the cervix was found. The Pap smear was II (reactive); HPV-DNA test was negative. The biopsy of the mass revealed PSCC with a high expression of p53, carcinoembryonic antigen (CEA), and Ki67 (50%). Staining for estrogen receptor (ER), progesterone receptor (PR), and vimentin was negative. The serum carbohydrate antigen 125 (CA-125) reached 159 U/ml. The patient was treated with radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy. A poorly-differentiated papillary-serous, non-secretory adenocarcinoma, pT1b1, pN0 (0/44), pM0, G3, R0, V0, L0, was confirmed. According to the German recommendations for early-stage cervical cancer, the patient received no adjuvant treatment. Currently, the patient is free of relapse 38 months after the diagnosis of cervical cancer and 87 months after that of breast cancer.
  
  
  CONCLUSIONS
  Immunohistochemistry is helpful in diagnosing rare entities. This case adds further evidence that the prognosis for early-stage PSCC is probably not poorer than that for other cervical adenocarcinomas.
authors.affiliation: Saint Joseph Hospital, Division of Gynaecology and Obstetrics, Sautierstr.1, Freiburg, Germany. saraband@gmx.net
authors.forename: Rafal
authors.initials: R
authors.lastname: Watrowski
authors.forename: Ellen
authors.initials: E
authors.lastname: Striepecke
authors.forename: Christoph
authors.initials: C
authors.lastname: Jäger
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauknecht
authors.forename: Catherina
authors.initials: C
authors.lastname: Horst
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D013629:Tamoxifen / Q000627:therapeutic use*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000378:metabolism / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen