Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5999-6004
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5999
Minimal deviation adenocarcinoma with elevated CA19-9: A case report
Yan Dong, Ying Lv, Jing Guo, Lin Sun
Yan Dong, Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
Ying Lv, Department of Radiology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Jing Guo, Department of Pathology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Lin Sun, Department of Obstetrics and Gynecology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
Author contributions: Dong Y drafted, reviewed, and revised the manuscript; Sun L was the primary physicians during the patient’s inpatient stay; Lv Y and Guo J provided the images; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Lin Sun, MD, Chief Doctor, Department of Obstetrics and Gynecology, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Road, Jining 272000, Shandong Province, China.
Received: January 28, 2021
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.

Keywords: Methylation, Minimal deviation adenocarcinoma, Positron emission tomography/computed tomography, Magnetic resonance imaging, Pathology, Case report

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.