Diagnostic dilemma in high intracanalar carcinoma of the cervix

The use of colposcopy for follow up of patients with abnormal cervical smears has considerably increased the rate of detection of cervical malignancies and intraepithelial lesions in recent years. In case the lesion is situated high up in the cervical canal however, the chances of missing out the lesion are considerable. In our case the malignancy was detected only on endocervical sampling, but was missed on scrape as well as on colposcopically directed biopsy. The patient who was in perimenopausal age group, had complaints of post coital bleeding. The initial cervical scrape smear showed only squamous metaplasia. Colposcopically directed biopsy also showed the same findings. On a high index of suspicion clinically, the endocervical sampling was done with a cytobrush, which showed squamous cell carcinoma (SCC) of the cervix. Subsequent hysterectomy of the patient confirmed the diagnosis. Simultaneous endocervical sampling considerably increases the chances of finding an intracanalar lesion, particularly in older women, in whom the transitional zone (TZ) is situated high up in the cervical canal. In such a situation, even a colposcopically directed biopsy may prove inadequate. This was amply proved in our case.