Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5999
Peer-review started: January 28, 2021
First decision: April 25, 2021
Revised: May 7, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 26, 2021
Minimal deviation adenocarcinoma is a rare malignancy with a high rate of misdiagnosis and high aggressiveness, and its diagnosis relies on histopathology. Surgical resection is the preferred and most effective treatment, but the outcomes are often unsatisfactory.
A 60-year-old perimenopausal woman was admitted to the hospital and found to have elevated CA19-9 on physical examination without abdominal pain or vaginal bleeding. Clinical examination and positron emission tomography/computed tomography examination were unremarkable, magnetic resonance imaging examination was suggestive of dominant cervical lesions, and methylation examination was suggestive of malignant lesions. Tissue samples were taken from the suspected cervical lesion, and the final pathologic diagnosis was minimal deviation adenocarcinoma. Based on the pathologic diagnosis of suspected minimal deviation adenocarcinoma, radical abdominal total hysterectomy, bilateral oophorectomy, and pelvic and para-aortic lymph node dissection were performed. The final histological report confirmed minimal deviation adenocarcinoma of the cervix, stage IB2, with lymph node metastasis. Minimal deviation adenocarcinoma is a tumor with aggressive clinical behavior.
Patients with minimal deviation adenocarcinoma have a lower survival rate than patients with conventional human papillomavirus-related cervical adenocarcinoma. A precise preoperative pathologic diagnosis may reduce the mortality rate due to missed optimal treatment with multiple surgical interventions. To date, there is no therapeutic consensus; therefore, each case must be treated individually.
Core Tip: Minimal deviation adenocarcinomas of the uterine cervix are mucinous adenocarcinomas not related to human papillomavirus. They are relatively rare, with atypical clinical presentation, low positive rate under cytology and pathological biopsy, high rate of misdiagnosis, high aggressiveness, and tendency to spread easily during the early stage. The methylation test also improves the specificity and sensitivity of early diagnosis of minimal deviation adenocarcinoma of the cervix.