Lethal endometrial recurrence after cone biopsy for microinvasive cervical adenocarcinoma

The follow up of microinvasive cervical adenocarcinoma treated conservatively is difficult because recurrences are often out of range and Pap smears difficult to interpret. A 30-year-old woman with a microinvasive adenocarcinoma with clear, but narrow, margins on cone biopsy was treated conservatively. After 2 years of close follow up in which no recurrence was detected, dilatation and curettage performed for infertility revealed adenocarcinoma invading secretory endometrium. The carcinoma resembled her cervical adenocarcinoma histologically, immunohistochemically and was HPV DNA 16 positive. A radical hysterectomy showed carcinoma involving the entire endometrium and the uppermost 3 mm of the endocervical canal, but sparing the remainder of the cervix. The patient died of disseminated carcinoma at the age of 34 years. The location of the recurrence was the reason it escaped detection for so long despite close follow up.