Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 149-156
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.149
Large pelvic mass arising from the cervical stump: A case report
Kai Zhang, Jing-Hong Jiang, Jia-Li Hu, Yu-Lin Liu, Xu-Hong Zhang, Ying-Mei Wang, Feng-Xia Xue
Kai Zhang, Jia-Li Hu, Yu-Lin Liu, Xu-Hong Zhang, Ying-Mei Wang, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
Jing-Hong Jiang, Department of Obstetrics and Gynecology, Zhongnan Hospital, Wuhan 430060, Hubei Province, China
Author contributions: Zhang K and Jiang JH drafted the table and manuscript; Hu JL searched the relevant literature and collected the data; Liu YL contributed to the design and revision of this study; Zhang XH edited and contributed to manuscript drafting; Wang YM were the patient’s obstetricians and reviewed the literature; Xue FX revised the final manuscript.
Supported by National Natural Science Foundation of China, No. 81772790 and No. 81602293; Postgraduate Innovation Fund of 13th Five-year Comprehensive Investment, Tianjin Medical University, No. YJSCX201812.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng-Xia Xue, MD, PhD, Academic Fellow, Professor, Senior Research Fellow, Surgical Oncologist, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China. fengxiaxue1962@gmail.com
Received: October 13, 2019
Peer-review started: October 13, 2019
First decision: November 13, 2019
Revised: November 17, 2019
Accepted: December 6, 2019
Article in press: December 6, 2019
Published online: January 6, 2020
Abstract
BACKGROUND

A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare. After supracervical hysterectomy, there is a risk of various lesions occurring in the cervical stump. We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy. Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes. If the cervix is retained, patients require a close follow-up.

CASE SUMMARY

A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass. Her chief complaint was abdominal distention for two months. She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior. Abdominal ultrasonography detected a 9.1 cm × 8.5 cm × 8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53 (HPV53) was positive. The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump. We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion. The pelvic mass was removed, and a bilateral adnexectomy was implemented. Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion. After successful intervention, the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.

CONCLUSION

When addressing benign uterine diseases, gynecologists should pay adequate attention to retaining the cervix. If the cervix is retained, patients require a close follow-up.

Keywords: High-grade squamous intraepithelial lesion, Large pelvic mass, Cervical cyst, Supracervical hysterectomy, Total hysterectomy, Case report

Core tip: A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare. To the best of our knowledge, this is the first case about this rare cervical cyst with cervical high-grade squamous intraepithelial lesion, which indicates that it should take careful consideration when handling with a stump cervix lesion. Gynecologists should choose the most suitable surgical method based on the patient’s wishes and condition. In dealing with benign uterine diseases, we should pay adequate attention to retaining the cervix. If the cervix is retained, patients require a close follow-up.