Single-organ vasculitis of the uterine cervix mimicking cervical cancer: A case report

Single-organ vasculitis (SOV) of the uterine cervix is extremely rare and presents significant diagnostic challenges when it mimics malignancy. A 22-year-old woman presented with fever, abdominal pain, and abnormal genital bleeding. Imaging revealed a 5 cm cervical mass with multiple lymphadenopathies, suggesting advanced cervical cancer. Cervical cytology revealed atypical glandular cells with frequent mitotic figures, suggesting cervical adenocarcinoma. The convergence of cytological, clinical, and imaging findings led to a compelling diagnosis of malignancy. However, no malignant findings were observed in the histopathological examination. The vascular media showed complete fibrinoid necrosis and the surrounding area demonstrated dirty necrosis with numerous nuclear fragments, consistent with necrotizing vasculitis. Atypical cells were confined to a very small area. Immunohistochemistry results were negative for p16. Remarkably, the mass regressed spontaneously during follow-up without any intervention. Follow-up cytology revealed persistent atypical features despite clinical resolution, creating a diagnostic dilemma requiring careful clinicopathological correlation. Pathological evaluation and careful observation the avoidance of unnecessary invasive treatments. The final diagnosis was single-organ cervical vasculitis. This appears to be the first reported case of a spontaneously resolving cervical SOV with cytological features indistinguishable from those of an adenocarcinoma. The case highlights the critical limitations of cytological diagnosis in differentiating severe inflammatory changes from malignancies. The experience emphasizes that tissue diagnosis is essential before radical intervention, particularly in young patients in whom fertility preservation is paramount, and demonstrates that cytological findings require careful clinical correlation to prevent unnecessary surgeries.