Minimal-deviation adenocarcinoma of the cervix encountered during hysteroscopic endometrial ablation

A 43-year-old, para 2, gravida 2 woman experienced menorrhagia. She had no risk factors for endometrial neoplasia, and five annual Papanicolaou smears, the last one 3 months earlier, were satisfactory for evaluation and within normal limits. During hysteroscopic endometrial ablation the endometrium appeared normal. The uterine-cervical cavity was normal other than a 1-cm, prominent, vascular, erythematous lesion in the posterior cervical canal, which was resected together with the entire endometrium. Pathology was reported as highly suggestive of a minimal-deviation adenocarcinoma of the cervix, and the patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. No residual cancer was found in the surgical specimen and the patient was alive and well 1 year later. Preablation evaluation is not adequate to detect all gynecologic malignancies. Routine resection of all unrecognizable lesions may identify rare tumors such as the one discovered in this woman.