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Home > Student Cases > Carcinoma of the cervix

Carcinoma of the cervix

Carcinoma of the cervix


Early invasive cervical squamous carcinoma
Early invasive cervical squamous carcinoma - removed by hysterectomy

Image used with permission, Image 1350 from Peir Digital Library – public access image database,
http://peir.path.uab.edu University of Alabama at Birmingham, Department of Pathology

 

Advanced cervical carcinoma with urinary obstruction
Advanced cervical carcinoma with urinary obstruction - removed at autopsy


Clinical data

  • The patient was an elderly woman who presented with post-menopausal bleeding, a foul smelling vaginal discharge, pain in the lower abdomen, dysuria and urinary frequency.
  • On vaginal examination a large fungating growth of the cervix was found.
  • She was given radiotherapy (palliative) but two weeks later she became mentally confused, then comatose, and died.

At autopsy

  • The specimen shows, in the lower half, the bisected uterus and cervix (flapped open) and base of bladder.
  • All these are extensively infiltrated by tumour tissue.

Bisected uterus
 

  • Just above the bladder the right ureter disappears into tumour.
  • Both ureters are dilated, the right more so.
  • The right kidney is atrophied while the left kidney is enlarged.
  • This indicates that obstruction of the right ureter preceded that of the left by a long enough interval to allow some compensatory hypertrophy of the left kidney.

Dilated ureters, right kidney atrophied, left kidney enlarged


Comment

  • Most patients with stage IV carcinoma of the cervix die in uraemia (renal failure) – this is explained by the anatomical proximity of the ureters to the cervix, just before they enter the bladder.
  • Advanced cervical carcinomas extend directly into contiguous tissues – vagina, rectum, bladder, ureters, paracervical tissue.
  • Obstruction of the ureters by tumour extension causes back pressure on the kidney, with dilatation of the renal pelvis and calyx, and atrophy of the functional renal parenchyma (=hydronephrosis).
  • Infection (pyelonephritis) often supervenes.

A useful link


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