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Case 1
Cervical neoplasia
R. Boeri, S. Gambini, V. Contini
– San Carlo Hospital - Milano
(pictures by dr. Boeri)
Clinical history
A 34 y.o. South American woman has a Pap smear done, which shows ( Picture 1) squamous cells with hyperchromatic and large nuclei, rare nucleoli and associated inflammation.
There is necrotic material in the background. The diagnosis is “squamous type malignant neoplastic cells”. The patient has a colposcopy done with a clinical diagnosis of “suspicious for invasive carcinoma, near the EUO, in particular of the posterior lip”. Biopsies are performed and they show an invasive malignant poorly differentiated neoplasia with large cells with prominent nucleoli and, rarely, squamous differentiation. There are also many inflammatory cells, in particular eosinophils ( picture 2 – picture 3 – picture 4 – picture 5). The diagnosis is “invasive, poorly differentiated squamous cell carcinoma, G3”. The patient undergoes radical hysterectomy with lymphadenectomy.
Macroscopicalal description
Uterus with a 3 cm, ulcerated neoplasia of the cervical posterior lip.
Microscopicalal description
Invasive, poorly differentiated malignant neoplasia with similar histological features to the biopsy ones. There is still the presence of a rich inflammatory component with a peri-neoplastic edge of eosinophils. There are superficial areas of squamous cell carcinoma with rare squamous pearls and marginal foci of in situ squamous cell carcinoma ( picture 6 – picture 7 – picture 8 – picture 9 – picture 10 – picture 11 – picture 12). The tumor shows focal positivity for Cytokeratin ( picture 13).
Diagnosis
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