Hematocervix and Hematometra: A Rare Case Report of HPV-16 Induced Cervical Intraepithelial Neoplasia (CIN)

Hematocervix and hematometra are uncommon manifestations of cervical intraepithelial neoplasia (CIN). While cervical stenosis is more commonly associated with senile at-rophy or post-procedural scarring, its occurrence in the context of CIN remains exceptionally rare.

A 49-year-old female presented to the gynaecology outpatient department with complaints of diffuse pain in the lower abdomen for the last 3 months. On examination, the vagina appeared atrophic, and a reddish-blue swelling was noted at the location of the cervix. Cough impulse was positive. On bimanual examination, the uterus was approximately 10 weeks in size, and a glob-ular swelling was palpable in the cervical region, which was soft, cystic, and boggy to the touch. USG and MRI confirmed hematocervix likely due to stenosis of the external os. On dilatation of the exter-nal os, about 250 ml of dark brown chocolate-coloured thick fluid was drained. Cervical biopsy was suggestive of intra-epithelial dysplasia (CIN III). HPV testing was positive for HPV-16. The patient was counselled for LEEP, followed by close surveillance, but instead she opted for a hysterectomy. Histopathology confirmed CIN III with features suggestive of cervical thinning characterized by ep-ithelial atrophy, underlying stromal fibrosis, and chronic inflammatory infiltrates comprising lym-phocytes and plasma cells, indicative of a longstanding inflammatory process.

Severe cervical thinning and hematocervix are uncommon but significant presentations of CIN. A high index of suspicion, timely histopathological evaluation, and appropriate management are essential in preventing adverse outcomes. This case highlights the importance of a comprehensive assessment in patients presenting with similar findings, particularly in those with risk factors or a history of cervical disease.