A Case of Human Papilloma Virus 31- and 68-Associated Metastatic Squamous Cell Carcinoma of the Cervix in a Healthy 28-Year-Old Woman

Abstract

Background: Cervical cancer is often a slowly progressing malignancy that presents in women with a mean age of 51. This case is a highly unusual presentation of metastatic squamous cell carcinoma (SCC). Case: A 28-year-old healthy, gravida 0, female - who was post a quadrivalent Gardasil® series with normal Papanicolaou smears - presented with abdominal pain, bloating, and postcoital bleeding. A colposcopy was significant for cervical intraepithelial neoplasia III. Cold knife cone was significant for SCC with positive margins. Human papilloma virus (HPV) typing was positive for HPV 31 and 68. Positron emission tomography was negative for metastasis. However, a radical hysterectomy started and then was abandoned due to the discovery of metastases to the sigmoid epiploica. Results: Pathology testing revealed that this patient had SCC with metastasis to the sigmoid epiploica and to 2 pelvic lymph nodes. Immunohistochemical staining was positive for p16. She was diagnosed with stage IVA SCC of the cervix and, as of this writing, stated that she intended to undergo radiation therapy followed by chemotherapy. Conclusions: When appropriate, a high index of suspicion is necessary to diagnose cervical cancer in low-risk individuals. (J GYNECOL SURG 34:159)