Fertility Preservation in Extramedullary Plasmacytoma of the Uterine Cervix: Global Literature Synthesis and First Case From Iran

Extramedullary plasmacytoma (EMP) most commonly arises in the head and neck, with exceedingly rare involvement of the uterine cervix. Only 16 published cases of cervical EMP have been reported since 1949. This study presents the first documented case from Iran and synthesizes all reported cases to analyze clinical patterns, diagnostic pitfalls, and management strategies.

A 32-year-old Iranian woman presented with postcoital bleeding after years of intermittent spotting. Comprehensive workup in March 2024, excluded multiple myeloma. Due to her desire for pregnancy, she declined hysterectomy and radiotherapy and underwent cervical conization in June 2024, with concurrent endocervical and endometrial sampling. We also conducted a systematic review of all published cervical EMP cases.

Our analysis of 16 published cervical EMP cases (including present case) demonstrates that clinical presentations are nonspecific, commonly postcoital bleeding or abnormal Pap smears, often leading to initial misdiagnosis. Treatment was highly individualized: 9 patients underwent surgery, 6 received radiotherapy (± surgery), and outcomes were generally favorable. Notably, fertility-sparing conization alone was associated with disease-free survival in three young patients, including ours, supporting the feasibility of fertility-sparing strategies under strict surveillance.

This case contributes critical evidence that organ-sparing management can be oncologically appropriate. Cervical EMP should be considered in differential diagnosis of atypical cervical lesions. In the absence of standardized guidelines, management must be tailored to patient values and anatomical context, not based on general EMP guidelines. Continued reporting of well-documented cases is critical to refine prognostic and therapeutic insights for this ultra-rare entity.