The serum carbohydrate antigen (CA)-199, carcinoembryonic antigen (CEA), CA-125, and CA-724 levels were normal. Thinprep cytology test (TCT) revealed atypical squamous cells of undetermined significance (ASCUS) HPV: negative. The size of the left ovary was normal, and a 7.7 × 3.6 × 1.6 cm cystic mass was seen in the left adnexal area, which was tortuous and tubular, with liquid inside and a clear boundary. Color Doppler flow imaging detected blood flow signals. The internal echo was uneven, and the boundary was clear ( Figures 1A,B). Pelvic ultrasound revealed that a mass around 2.3 × 1.8 × 1.7 cm was seen in the lower part of uterine cavity. On gynecological examination, the vulva and vagina were normal, a small amount of secretion could be seen, the cervix was of normal size with a smooth surface, the uterus was normal, the left adnexa were thickened and accompanied by slight tenderness. Then the patient was referred to our hospital. The results showed left hydrosalpinx, about 7.5 × 3.4 cm, and in addition to the IUD and cervical Nabothian cysts, a slightly strong echo mass was seen in the uterine cavity. The patient underwent pelvic ultrasound again on May 26, 2021. Her symptoms were relieved after anti-inflammatory treatment, but slight intermittent pain persisted in the lower abdomen. The results showed a cystic mass in the left adnexa, about 7.6 × 1.4 cm, with a high possibility of hydrosalpinx an intrauterine device (IUD) and liquid dark area in the uterine cavity, and Nabothian cysts in the cervix. On June 15, 2021, the patient visited our hospital for “intermittent left lower abdominal pain for 1 year.” In May 2020, pelvic ultrasound was performed in another hospital because of left lower abdominal pain and fever. Cesarean section followed by right adnexectomy, which was performed due to a right ovarian cyst, was performed in 1995. The patient was a 50-year-old premenopausal female, gravida 2, para 1. However, pathology confirmed the diagnosis of GAS. Here, we present a patient with GAS with lower uterine cavity involvement, which was misdiagnosed as submucosal myoma during hysteroscopic surgery. The clinical manifestations are not specific, the focus is hidden, and the positive rate of screening and biopsy is low, which brings great challenges to timely and correct diagnosis. The most common histological type of the HPVI group is gastric-type ECA (GAS) ( 4), which has a worse prognosis than HPVA ( 5). In the 2020 World Health Organization (WHO) classification of female genital tumors, ECAs are subclassified into human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) groups based on their distinct etiology and clinical behavior ( 3). ECA accounts for 20–25% of invasive cervical cancers, and its incidence is gradually increasing ( 2). However, a few are not, such as some endocervical adenocarcinoma (ECA). Most cervical cancers are related to the continuous infection of high-risk human papillomavirus (HPV). The appearance is occasionally similar to that of submucosal myoma, resulting in difficult preoperative diagnosis and even misdiagnosis.Ĭervical cancer is the fourth most common gynecological malignancy worldwide ( 1). GAS may be located in the upper endocervix or even reach the uterine cavity. However, pathology revealed that it was a GAS. During hysteroscopic surgery, we suspected that it may be a submucosal myoma. We considered the lesion to be a polyp before surgery. Preoperative images showed left hydrosalpinx and a lesion that was mainly located in the lower part of the uterine cavity. We report the case of a 50-year-old Chinese woman who presented with intermittent left lower abdominal pain for 1 year. The preoperative diagnosis of GAS is often difficult because of its nonspecific clinical manifestations and special lesion location. Gastric-type endocervical adenocarcinoma (GAS) is considered a distinct and clinically important entity because it is unrelated to human papillomavirus infection and has aggressive behavior and worse clinical outcomes than the usual type of endocervical adenocarcinoma (ECA). Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.Jiao Wang Qing Yang Dandan Wang Mengyuan Li Ningning Zhang *
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