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It is more than uterine fibroids: Incidental discovery of adenoma malignum of the cervix

Abada E

Malays J Pathol, 2022 Dec;44(3):533-538.
PMID: 36591722

Adequate sampling of gross pathology specimens and attention to microscopic details is crucial in establishing the correct diagnosis in a patient, regardless of a benign pre-surgical diagnosis. Adenoma malignum is a rare HPV-negative variant of well-differentiated adenocarcinoma of the endocervix. It is difficult to diagnose in surgical pathology specimens due to its deceptively-benign appearance. This was a case of a 43-year-old woman with a history of menorrhagia and metrorrhagia and radiology interpretation of degenerating uterine fibroids. Pre-operative Pap testing and hysteroscopic dilatation and curettage were non-contributory. Following surgery, microscopic examination of the cervix revealed well-spaced, deeply-invasive, variably-sized glands with irregular outlines/haphazard arrangements, lined by cells showing mild to moderate cytologic atypia. These cells were positive for p53 and CK7 on Immunohistochemistry and Ki-67 showed a high proliferative index. Monoclonal CEA, calretinin, CD10, and P16 were all negative. A diagnosis of adenoma malignum stage pT1b2 was made. The patient was subsequently placed on platinum-based chemotherapy and is doing well 2 years after her diagnosis. Cases such as this, underscore the importance of adequately sampling surgical resection specimens, with careful attention to microscopic details as incidental pathologies may be unearthed which could have significant implications on a patient's clinical outcome.

Matched MeSH terms: Cervix Uteri/pathology; Cervix Uteri/surgery
The effects of oestradiol and relaxin on extensibility and collagen organisation of the pregnant rat cervix

Cheah SH, Ng KH, Johgalingam VT, Ragavan M

J Endocrinol, 1995 Aug;146(2):331-7.
PMID: 7561646

The effects of exogenously introduced oestradiol-17 beta (E) and relaxin (RLX) on cervical extensibility and collagen organisation were tested in rats ovariectomised in late pregnancy. When the cervices were stretched in vitro by 1 mm increments, it was found that those from rats given E alone generated significantly higher tensions than those from control rats, while cervices from rats given both E and RLX had tensions similar to controls. Examination of cervical sections under the light microscope and ultra-thin sections under the electron microscope showed that the collagen fibres in the cervices from E-treated rats were highly organised, whereas those from animals given E+RLX and control animals were disorganised and dispersed. It was concluded that E decreased cervical extensibility, while RLX counteracted the effect of E to maintain a soft and easily extensible cervix.

Matched MeSH terms: Cervix Uteri/anatomy & histology; Cervix Uteri/drug effects*; Cervix Uteri/physiology; Cervix Uteri/ultrastructure
Brugia malayi in a cervical smear

Leong AS

Am J Trop Med Hyg, 1976 Jul;25(4):655-6.
PMID: 961988

A microfilaria, identified as that of Brugia malayi, was found in a routine cervical smear from a healthy, 38-year-old female Malaysian aborigine.

Matched MeSH terms: Cervix Uteri/parasitology*
Six vs 12 hours of Foley catheter balloon placement in the labor induction of multiparas with unfavorable cervixes: a randomized controlled trial

Kamarudzman N, Omar SZ, Gan F, Hong J, Hamdan M, Tan PC

Am J Obstet Gynecol MFM, 2023 Nov;5(11):101142.
PMID: 37643690 DOI: 10.1016/j.ajogmf.2023.101142

BACKGROUND: Planned 6- vs 12-hour placement of the double-balloon catheter for cervical ripening in labor induction hastens delivery. The Foley catheter is low-priced and typically performs at least as well as the proprietary double-balloon devices in labor induction. Maternal satisfaction with labor induction is usually inversely related to the speed of the process.
OBJECTIVE: This study aimed to compare Foley balloon placement for 6 vs 12 hours in the labor induction of multiparas with unfavorable cervixes.
STUDY DESIGN: A randomized controlled trial was conducted in a university hospital in Malaysia from January to October of 2022. Eligible multiparous women admitted for induction of labor for various indications were enrolled. Participant inclusion criteria were multiparity (at least 1 previous vaginal delivery of ≥24 weeks' gestation), age ≥18 years, term pregnancy >37 weeks' gestation, singleton pregnancy, cephalic presentation, intact membranes, normal fetal heart rate tracing, no significant contractions (< 2 in 10 minutes), and unfavorable cervix (Bishop score < 6). Participants were randomized after successful Foley balloon insertion for the balloon to be left in place for 6 or 12 hours of passive ripening before removal to check cervical suitability for amniotomy. The primary outcomes were the induction-to-delivery interval and maternal satisfaction with the allocated intervention assessed using a visual numerical rating scale (0-10). Secondary outcomes were derived in part from the core outcome set for trials on induction of labor (Core Outcomes in Women's and Newborn Health [CROWN]). Maternal outcomes were change in first Bishop score after intervention, use of additional method for cervical ripening, time to delivery after balloon removal, mode of delivery, indication for cesarean delivery, duration of oxytocin infusion, blood loss during delivery, presence of third- or fourth-degree perineal tear, maternal infection, use of regional analgesia in labor, length of hospital stay, intensive care unit (ICU) admission, cardiorespiratory arrest, and need for hysterectomy. The secondary neonatal outcomes were Apgar score at 1 and 5 minutes, neonatal intensive care unit (NICU) admission, cord blood pH, neonatal sepsis, birthweight, birth trauma, hypoxic-ischemic encephalopathy, or need for therapeutic hypothermia. Analyses were conducted with the t-test, Mann-Whitney U test, chi-square test, and Fisher exact test, as appropriate.
RESULTS: A total of 220 women were randomized (110 to each intervention). Regarding the 2 primary outcomes, the induction-to-delivery intervals were a median (interquartile range) of 15.9 (12.0-24.0) and 21.6 (17.3-26.0) hours (P

Matched MeSH terms: Cervix Uteri*
Fulltext Characterizing the temporal dynamics of human papillomavirus DNA detectability using short-interval sampling

Liu SH, Cummings DA, Zenilman JM, Gravitt PE, Brotman RM

Cancer Epidemiol Biomarkers Prev, 2014 Jan;23(1):200-8.
PMID: 24130223 DOI: 10.1158/1055-9965.EPI-13-0666

Variable detection of human papillomavirus (HPV) DNA can result in misclassification of infection status, but the extent of misclassification has not been quantitatively evaluated.

Matched MeSH terms: Cervix Uteri/virology*
Cervicograms of normal labour in Malaysian women

Peng WW, Aun LM, Sinnathuray TA, Lin WM

Med J Malaysia, 1976 Jun;30(4):261-3.
PMID: 979726
Matched MeSH terms: Cervix Uteri/physiology*
Fulltext Novel Complex of Zinc (II) Dichloroethylenediamine: Synthesis, Characterization, In-silico, and In-vitro Evaluation against Cervical Cancer Cells

Raya I, Kartina D, Wijaya RI, Irfandi R, Abdalrazaq EA, Prihantono P, et al.

Asian Pac J Cancer Prev, 2023 Dec 01;24(12):4155-4165.
PMID: 38156851 DOI: 10.31557/APJCP.2023.24.12.4155

OBJECTIVE: Cervical cancer is a malignancy originating from the cervix and often caused by oncogenic Human Papilloma Virus (HPV), specifically subtypes 16 and 18. Anticancer drugs are chemotherapeutic compounds used for cancer treatment. Therefore, this research aims to synthesize and characterize Zinc (II) dichloroethylenediamine (Zn(en)Cl2) complex, as well as determine its antiproliferative activity against HeLa cells. The Zn(en)Cl2 complex was successfully synthesized, and the antiproliferative activity was tested.
METHODS: The synthesis involved reacting ethylenediamine and KCl with Zn metal. The complex formed was characterized using a conductometer, UV-Vis spectroscopy, FT-IR spectroscopy, and XRD, while the activity was measured against HeLa cells.
RESULT: The synthesis yielded a 56.12% conversion with a melting point of 198-200 oC and a conductivity value of 2.02 mS/cm. The Zn(en)Cl2 complex showed potential activity against HeLa cells with an IC50 value of 898.35 µg/mL, which was evidenced by changes in the morphological structure of HeLa cells. Its interaction with DNA targets was investigated by employing molecular docking.
CONCLUSION: The observed data indicated that the Zn(en)Cl2 complex bound to DNA at the nitrogenous base Guanine (DG) by coordinate covalent bonds. Interestingly, DG maintained interaction with the complex until the end of the docking simulation. Additionally, molecular dynamics (MD) simulation was conducted, and the results showed that Zn(en)Cl2 remained bound to the DNA binding pocket all through the process.

Matched MeSH terms: Cervix Uteri/metabolism
Fulltext Evaluating Nuclear Membrane Irregularity for the Classification of Cervical Squamous Epithelial Cells

Tang JR, Mat Isa NA, Ch'ng ES

PLoS One, 2016;11(10):e0164389.
PMID: 27741266 DOI: 10.1371/journal.pone.0164389

Pap test involves searching of morphological changes in cervical squamous epithelial cells by pathologists or cytotechnologists to identify potential cancerous cells in the cervix. Nuclear membrane irregularity is one of the morphological changes of malignancy. This paper proposes two novel techniques for the evaluation of nuclear membrane irregularity. The first technique, namely, penalty-driven smoothing analysis, introduces different penalty values for nuclear membrane contour with different degrees of irregularity. The second technique, which can be subdivided into mean- or median-type residual-based analysis, computes the number of points of nuclear membrane contour that deviates from the mean or median of the nuclear membrane contour. Performance of the proposed techniques was compared to three state-of-the-art techniques, namely, radial asymmetric, shape factor, and rim difference. Friedman and post hoc tests using Holm, Shaffer, and Bergmann procedures returned significant differences for all the three classes, i.e., negative for intraepithelial lesion or malignancy (NILM) versus low grade squamous intraepithelial lesion (LSIL), NILM versus high grade squamous intraepithelial lesion (HSIL), and LSIL versus HSIL when the span value equaled 3 was employed with linear penalty function. When span values equaled 5, 7, and 9, NILM versus LSIL and HSIL showed significant differences regardless of the penalty functions. In addition, the results of penalty-driven smoothing analysis were comparable with those of other state-of-the-art techniques. Residual-based analysis returned significant differences for the comparison among the three diagnostic classes. Findings of this study proved the significance of nuclear membrane irregularity as one of the features to differentiate the different diagnostic classes of cervical squamous epithelial cells.

Matched MeSH terms: Cervix Uteri/pathology
Fulltext A rare synchronous presentation of primary malignant melanoma in cervix and vagina

Pai UKN, Pillai S, Arunkumar NR

J Cancer Res Ther, 2023 Oct 01;19(7):2108-2110.
PMID: 38376333 DOI: 10.4103/jcrt.jcrt_1309_21

Malignant melanoma, primarily a cutaneous malignancy, can also involve mucosal surfaces and constitutes 2% to 7% of all gynecological malignancies. Primary melanoma of the uterine cervix is an uncommon tumor and has poor prognosis. In the female genital tract, the synchronous occurrence of primary malignant melanoma in the cervix and vagina is rare. We report a case of a 48-year-old female patient who presented with a blackish vaginal mass and associated growth in the cervix. Biopsy from the vaginal mass was reported as malignant melanoma. Following this, she underwent radical surgery and adjuvant radiotherapy. After 12 months, the patient is doing well.

Matched MeSH terms: Cervix Uteri
Squamous cell carcinoma cervix stage IIIB metastatic to oral cavity: A case report and literature review

Purbadi S, Saspriyana KY, Rustamadji P

Med J Malaysia, 2020 07;75(4):450-451.
PMID: 32724016

Metastatic cervical cancers to the oral cavity are uncommon. These metastases most commonly present as lesions of the jaw bones and the mandible. A 57-year-old female patient complained of mass lesion in her oral cavity after definitive treatment for squamous cell carcinoma of the cervix stage IIIB. On examination a swelling of 3cm in size was found on the left side of buccal vestibule adjacent to the lower canine tooth. Wide local excision was performed, and histopathology results showed a squamous cell carcinoma of moderate differentiation. She was continued with segmental mandibulectomy, supraomohyoid neck dissection and plate-screw reconstruction. Radiotherapy was given as an adjuvant therapy.

Matched MeSH terms: Cervix Uteri/pathology*; Cervix Uteri/surgery*
Fulltext Unusual finding of endocervical-like mucinous epithelium in continuity with urothelium in endocervicosis of the urinary bladder

Cheah PL, Looi LM, Lee GE, Teoh KH, Mun KS, Nazarina AR

Diagn Pathol, 2011;6:56.
PMID: 21699710 DOI: 10.1186/1746-1596-6-56

Endocervicosis in the urinary bladder is a rare benign condition. We present a case in a 37-year-old woman with classical clinical and pathological features of endocervicosis. The unusual observation of endocervical-like mucinous epithelium in continuity with the urothelium in addition to fully developed endocervicosis prompted immunohistochemical profiling of the case using antibodies to cytokeratins (AE1/AE3, CK19, CK7, CK5/6, CK20), HBME-1, estrogen receptor (ER) and progesterone receptor (PR) to assess the relationship of the surface mucinous and endocervicosis glandular epithelia. The surface mucinous epithelium, urothelium and endocervicosis glands were immunopositive for AE1/AE3, CK7 and CK19 while CK20 was only expressed by few urothelial umbrella cells. The surface mucinous epithelium was CK5/6 and HBME-1 immunonegative but showed presence of ER and PR. This was in contrast to the urothelium's expression of CK5/6 but not ER and PR. In comparison, endocervicosis glands expressed HBME-1, unlike the surface mucinous epithelium. The endocervicosis epithelium also demonstrated the expected presence of ER and PR and CK5/6 immunonegativity. The slightly differing immunohistochemical phenotypes of the surface mucinous and morphologically similar endocervicosis glandular epithelium is interesting and requires further clarification to its actual nature. The patient has remained well and without evidence of disease 18-months following transurethral resection of the lesion.

Matched MeSH terms: Cervix Uteri/metabolism; Cervix Uteri/pathology*
Endometrial and endocervical secretion: the search for histochemical differentiation

Nieuwenhuizen L, Khalil MK, Venkatesh N, Othman NH

Anal. Quant. Cytol. Histol., 2006 Apr;28(2):87-96.
PMID: 16637511

To determine the ideal histochemical stain to differentiate between non-neoplastic and neoplastic endocervix and endometrium.

Matched MeSH terms: Cervix Uteri/pathology; Cervix Uteri/secretion*
Fulltext A randomised double-blind study of vaginal misoprostol vs dinoprostone for cervical ripening and labour induction in prolonged pregnancy

Lee HY

Singapore Med J, 1997 Jul;38(7):292-4.
PMID: 9339095

Dinoprostone, is presently used in our standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol has been found to be a good substitute. In view of the potential saving it might offer, we set out to test its efficacy against the standard dinoprostone.

Matched MeSH terms: Cervix Uteri/drug effects*; Cervix Uteri/physiopathology
Role of phIGFBP-1 and ultrasound cervical length in predicting pre-term labour

Azlin MI, Bang HK, An LJ, Mohamad SN, Mansor NA, Yee BS, et al.

J Obstet Gynaecol, 2010;30(5):456-9.
PMID: 20604646 DOI: 10.3109/01443615.2010.489162

This prospective observational study was to evaluate the efficacy of combining phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and transvaginal ultrasound cervical length (CL) compared with either indicator alone in predicting pre-term labour (PTL). Women with singleton pregnancy between 24 and 36 weeks' gestation with evidence of PTL were subjected to phIGFBP-1 and CL tests. Of the 51 women, five were tested positive (phIGFBP-1 positive and CL <2.5 cm) for combination of phIGFBP-1 and CL (four delivered within 1 week), whereas 46 tested negative, of which, only one delivered. A much higher negative predictivity (NP), positive predictivity (PP) and specificity (SP) in the combination test was seen compared with phIGFBP-1 or CL alone (NP: 97.8% vs 97.7% vs 97.1%; PP: 80.0% vs 51.1% and CL 23.5%; SP: 97.8% vs 93.5% vs 71.1%, respectively). The cervical os dilatation of 2 cm with combined positive test (p = 0.001) indicated a higher likelihood of PTL.

Matched MeSH terms: Cervix Uteri/metabolism; Cervix Uteri/secretion; Cervix Uteri/ultrasonography*
Fulltext Villoglandular papillary adenocarcinoma of the uterine cervix with lymph node metastasis - a case report and review of the literature

Geok, Chin Tan, Mohd Sidik Shiran, Manickam Swaminathan, Ali Siti Aishah, M.D., Poo, Ling Ong, Mohd Dali Ahmad Zailani Hatta

Medicine & Health, 2006;1(1):85-90.
MyJurnal

Villoglandular papillary adenocarcinoma was first described by Young and Scully in 1989 as a distinct entity with the histological features of exophytic growth proliferation, villous and papillary architecture and mild to moderate nuclear atypia. We report one case of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix with lymph node metastasis and reviewed the clinicopathological features of six other cases reported in the literature. Our patient is the seventh similar reported cases. They ranged in age from 29 to 54 (mean, 41) years. Five had lymphovascular invasion. All except our patient were treated with radical hysterectomy and radiotherapy. She was followed-up for 7 months and unfortunately died due to chest infection.

Matched MeSH terms: Cervix Uteri
Neuroendocrine carcinoma of the cervix: Review of classification and current developments in diagnosis and management

Kavitha Nagandla, Sharifah Sulaiha, Sivalingam Nalliah, Norfadzilah Mohd Yusof

International e-Journal of Science, Medicine & Education, 2017;11(1):2-11.
MyJurnal

Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.

Matched MeSH terms: Cervix Uteri
Fulltext Malignant mixed mullerian tumour, heterologous in a 66-year-old malay lady - a case report

Rahman MT, Naik VR, Noor SR, Mahmud NM, Isa M

Malays J Med Sci, 2003 Jul;10(2):93-5.
PMID: 23386805

A 66-year-old Malay woman, known hypertensive, presented with post menopausal bleeding associated with clot for three months. She was postmenopausal for last ten years. She also complaints of developing a mass in the abdomen which was growing in size also for last three months. Abdominal examination revealed a twenty week size mass, movable from side to side but unable to get below the mass. Vaginal examination revealed a fleshy fungating mass arising from the uterus coming out through the vagina. Cervix could not be visualized properly. Subsequent histopathology of the removed mass was reported as a Malignant Mixed Mullerian Tumour - Heterologous.

Matched MeSH terms: Cervix Uteri
Human papillomavirus in cervical cancers of Malaysians

Cheah PL, Looi LM, Sivanesaratnam V

J Obstet Gynaecol Res, 2011 Jun;37(6):489-95.
PMID: 21349124 DOI: 10.1111/j.1447-0756.2010.01386.x

With cervical carcinoma remaining the second leading cancer among Malaysian women, it is imperative to clarify the prevalence of human papillomavirus (HPV) in this respect, considering the dearth of local information.

Matched MeSH terms: Cervix Uteri/virology*
Transvaginal sonography of cervical length and Bishop score as predictors of successful induction of term labor: the effect of parity

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J

Clin Exp Obstet Gynecol, 2009;36(1):35-9.
PMID: 19400416

OBJECTIVE: To evaluate the predictive value for successful labor induction of transvaginal ultrasound (TVS) of cervical length according to parity.
METHOD: TVS of the cervix was performed before term labor induction. Induction was considered successful if vaginal delivery was achieved within 24 hours; 231 women were available for final analysis.
RESULTS: Analysis of the receiver operator characteristics curve showed an optimal cut-off for cervical length of < or = 20 mm for successful induction. Following multivariate logistic regression analysis, a sonographic short cervix (AOR 5.6; p < 0.001) was an independent predictor of successful induction but not a favorable Bishop score (p = 0.47). Among multiparas with a short cervix, positive and negative predictive values for successful induction were 98% (95% CI 90-100%) and 21% (95% CI 13%-32%) and among nulliparas, predictive values were 69% (95% CI 53%-82%) and 77% (95% CI 64%-87%) respectively.
CONCLUSION: In nulliparas, cervical length can usefully predict labor induction outcome.

Matched MeSH terms: Cervix Uteri/anatomy & histology*
Fulltext Role of mid-trimester transvaginal cervical ultrasound in prediction of preterm delivery

Hebbar S, Samjhana K

Med J Malaysia, 2006 Aug;61(3):307-11.
PMID: 17240581 MyJurnal

Ultrasonographic cervical length assessment is increasingly being utilized clinically to identify women at risk for spontaneous preterm delivery. In a randomised prospective longitudinal study involving 200 women, we measured cervical length and internal os diameter by transvaginal scan at 20 - 24 weeks and analysed their ability to predict preterm birth. The risk of spontaneous preterm delivery increased steeply as cervical length decreased. At cut off value of < or = 2.5cm, the cervical length measurements had sensitivity, specificity, positive predictive value and negative predictive value of 77%, 95%, 56% and 98% respectively. However, internal os diameter lacked sensitivity and specificity. Our data suggests that the duration of pregnancy is directly related to length of the cervix: the shorter the cervix, the greater the chance of preterm delivery.

Matched MeSH terms: Cervix Uteri/ultrasonography*

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