clinico pathological conference on cervical cancer Incidence of caners in Pakistan is really under reported cervical cancer is fourth most common cancer in Pakistan major burden od cervical cancer seen in low and middle income countries

1. INVESTIGATIONS:
FBC (Full blood count) LFT
Blood group UCE
RBS (Random Blood
Sugar)
HBsAG/Anti-HCV
Urine R/E (Routine test)

2. FULL BLOOD
COUNT:
• RBC count: 4.2 million/mm3
• Hb level: 9.1g/dl
• Hematocrit: 34%
• Mean corpuscular volume: 65fl
• Mean corpuscular hemoglobin:
28pg
• Mean corpuscular hemoglobin
concentration: 30g/dl
• WBC count: 7100/mm3
• Platelet count: 250000/mm3

3. BLOOD GROUP
•O+ve

4. INVESTIGATIONS:
Random
Blood sugar:
114mg/dl
Urea : 28mg
Creatinine:
0.9mg
Na+ :
134meq/L
K+ :
3.6meq/L
Cl- : 99meq/L
HCO3:
21meq/L

5. LIVER
FUNCTION
TEST
•Bilirubin: 0.5mg
•Direct bilirubin: 0.21mg
•Indirect bilirubin: 0.29mg
•ALP: 150U/L
•GGT: 14U/L
•SGPT: 35U/L

6. SCREENING
•Hepatitis B,C: ----
ve

7. COAGULATION
PROFILE
• PT= 13 SECONDS
CONTROL 12 SECONDS.
• APTT= 28 SECONDS
CONTROL 28 SECONDS.

8. SPECIFIC
PAP SMEAR:
•Atypical Squamous
cells.

9. MRI PELVIS:
 The small well-defined cystic area
noted in the right adnexal region
appears hypointense on T1 and
hyperintense T2W images.
 It measures approx. 2.2* 1.9 cm.
Findings likely represent dominant
follicle/ follicular retention cyst.

10. MRI PELVIS:
 A small abnormal signal intensity
area seen in the fundus of the uterus
appears hypointense, showing no
significant postcontrast
enhancement. Likely represents a
small intramural fibroid.
 Thickening of cervical canal noted
causing dilatation of uterine cavity.
 The rest of the scan is unremarkable.

11. .

12. MANAGEMENT:
• Total abdominal hysterectomy bilateral Salpingo Ooophorectomy
done and sample send for Histopathology

13. HISTO PATHOLOGY SHOWED:
Simple endometrial
hyperplasia without atypia
& and chronic nonspecific
endometritis.
Small intramural
leiomyoma,
uterus.
Minimally invasive moderately
differentiated nonkeratinizing
squamous cell carcinoma of cervix
Figo Stage 1A
Haemorrhagic
cystic corpus
luteum, one
ovary.

14. HISTO PATH BLOCKS WERE REVIEWED FOR SECOND
OPINION BY AKUH:
Cervix: Moderately
differentiated Non
keratinizing
squamous cell
carcinoma HPV
Stromal invasion
0.1cm, and
horizontal extent
0.9cm
Lvi : identified
Margins: ectocervical
resection margin :
0.1cm, deep
circumferential
margin : 1.2cm
Figo stage 1A1

15. CONTINUED
Endometrium:
Autolysed
endometrium
Myometrium:
Histologically
unremarkable
Ovary: corpus
luteum.
No comment was
done on vaginal &
adnexal involvement
due to limited
specimen
Lymph nodes : Not
received

16. POST SURGICAL
MRI PELVIS:
• Showing post-surgical
changes.
• No abnormal intensity
enhancing lesion was seen
to suggest recurrent/
residual disease
• Patient referred to
NORIN Hospital

17. • Then patient underwent EBRT 45 Gy in 25 Fx
with weekly Cisplatin
• vaginal brachtherapy
• HDR Brachytherapy total of 18Gy in 3
Fractions

18. 1ST FOLLOW UP:
• 1ST follow up done after 3months
• MRI pelvis was done
• That showed no
recurrent/ residual
disease noted in surgical
bed. Patient was also
doing well with no active
complains

19. 2ND FOLLOW UP
• After 3month of 1st follow-up
patient complained of constant
lower abdominal and back pain
• Excessive watery discharge with
occasional spotting.
• On vaginal examination:
thickening of
the stump was palpable with mild
PV bleeding
• Patient was then again advised
MR pelvis with contrast.

20. CT SCAN DONE
• That showed Ill defined
heterogeneously enhancing
lesion seen in the right side of
the pelvis at the site of the
stump causing indentation of
the posterior wall of the bladder
with loss of fat planes. Likely
representing recurrence of
disease at the surgical bed. It
measures 3.2 * 2.8cm.on

21. Ct scan

22. . Ct scan

23. • She presented to
us with blood-
stained vaginal
discharge
• we planned for
•EUA and
biopsy.

24. • THE HISTOPATHOLOGY REPORT OF THE
BIOPSY DONE :
• MODERATELY
DIFFERENTIATED
NONKERATINIZING
SQUAMOUS CELL
CARCINOMA. GRADE 2.

25. • Now the question is how to proceed
with this case.
• Chemotherapy
• Exenteration
• Re-Rt.

26. .