Papillary Serous Carcinoma of the Uterine Cervix with Lung Metastasis

Papillary serous carcinoma of the uterine cervix is a rare histological variant of cervical adenocarcinoma, with a very small number of cases reported. It is an aggressive tumor and is usually diagnosed at advanced stages by the time of diagnosis. Early-stage tumors can be treated with surgery and/or radiotherapy, while late-stage tumors have been treated with chemotherapy plus radical surgery with intermittent success. Here we report a case of metastatic papillary serous carcinoma observed at our hospital, which has been treated with debulking surgery and combination chemotherapy with carboplatin and paclitaxel. 1. Introduction Cervical adenocarcinoma accounts for 10–20% of invasive cervical cancers and has a poor radiosensitivity and chemosensitivity [1, 2]. Papillary serous carcinoma of the uterine cervix (PSCC) is a very rare variant of cervical adenocarcinoma, which histologically resembles the same tumor occurring more commonly in the ovary, fallopian tube, endometrium, and peritoneum [3]. It is recognized as an aggressive neoplasm that can be pure or mixed with other adenocarcinoma subtypes [3]. PSCC is staged similarly to other types of cervical cancer and is presented in Table 1 [4]. It is usually found with lymph node metastases and occasionally in Stage III or IV (staging is presented in Table 1) [2]. The diagnosis of PSCC should be made after metastasis from other sites, particularly the endometrium, has been excluded [5]. There is a paucity of the literature on PSCC with only 46 cases being reported to date [2]. Here we describe a recent case of primary PSCC with pulmonary metastases diagnosed at our hospital. Table 1: Carcinoma of the cervix uteri: Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) staging system (adapted from Reference [ 4]). 2. Case Presentation A 64-year-old African American female, gravida (G) 0 with menopause at age 52, presented with a four-week history of vaginal bleeding in July 2013. The bleeding occurred daily, ranging in severity from spotting to moderate bleeding. Her review of systems was otherwise negative, and she had no documented past medical history. She reported that her last Pap smear was performed several years ago and was normal. The vital signs were unremarkable. On pelvic examination, cervical ulceration of 2-3？cm with friability was found. The physical examination was otherwise unremarkable. Laboratory investigations showed only microcytic anemia with a hemoglobin level of 11.3？g/dL (normal range: 14.0–18.0？gm/dL) and CA-125 of 343 (normal range: 0–35？U/mL). On transabdominal