Abstract:

The typical manifestation of cervical cancer is irregular vaginal bleeding. However, in postmenopausal women, due to cervical atrophy, retraction of the transformation zone, and the possible endophytic growth of tumors, clinical symptoms are often atypical, and biopsy results are prone to false- negatives, increasing the risk of missed diagnosis. This paper reports a 69-year-old female patient who presented with lower abdominal pain. Imaging examinations showed a cystic mass of about 7 cm formed by hematometra in the uterus. Tumor markers were normal, and human papilloma virus 58 (HPV58) was positive. Cervical biopsy indicated chronic inflammation. Given the discrepancy between imaging and pathological results, a multi-disciplinary team decided to perform exploratory laparotomy after discussion. Intraoperative frozen-section examination diagnosed squamous cell carcinoma of the cervix. Subsequently, radical hysterectomy+ bilateral salpingo-oophorectomy + pelvic lymph node dissection were performed. Postoperative pathology confirmed moderately differentiated non-keratinizing squamous cell carcinoma. The tumor invaded more than two-thirds of the cervical stroma and involved the parametrium tissues. The final diagnosis was FIGO 2018 StageⅡB, and adjuvant chemoradiotherapy were required. After the operation, the patient received one course of chemotherapy with paclitaxel 240 mg (D1) combined with cisplatin 30 mg (D1-3). Currently, she is undergoing pelvic external beam radiotherapy with concurrent cisplatin 30 mg/week for radiosensitizer. Her condition remains stable, and she has been enrolled in the standardized follow-up management. By summarizing the clinical manifestations, imaging features, diagnosis, and treatment of this patient, this paper aims to remind clinicians that for postmenopausal women with unexplained hematometra, the possibility of endophytic cervical cancer should be alerted, providing a reference for the early identification and standardized management of similar cases.

Key words: Uterine cervical neoplasms, Carcinoma, squamous cell, Postmenopause, Hematometra, Frozen sections