A 78-year-old woman, postmenopausal for the last 30 years, presented to our gynecology outpatient department with symptoms of vaginal discharge for the last 3 weeks, associated with weakness and fever. The discharge was foul smelling and yellowish with a reddish tinge. There was no history of urinary frequency, diabetes, or tuberculosis. Her parity score was P4L4, with all 4 pregnancies being full-term vaginal delivery and the last pregnancy was 50 years ago. The patient underwent tubal ligation 46 years ago and also gave a history of surgery for intertrochanteric fracture of the femur neck, which was uneventful.
On examination, the patient was moderately built and moderately nourished, with mild pallor. The abdomen was soft and non-tender. Per-speculum examination revealed the cervix, which was bleeding on touch. On vaginal examination, 6-8 weeks anteverted uterus with parametrial tenderness was noted.
Lab test revealed 11.3 gm% hemoglobin with 11800/cumm total leucocyte count, with other parameters being normal. Radiological examination was advised and the MRI result was reported as a mass lesion in the cervix, with irregular margins extending into two-thirds of the myometrium superiorly and the upper one-third of the vagina inferiorly, with loss of fat planes between the uterus and posterior wall of the bladder and anterior wall of the rectum (Figure 1).
In view of clinical and radiological findings, a preoperative diagnosis of cervical carcinoma was made. Cervical and endometrial biopsies were taken under anesthesia and sent for histopathological examination. Intra-operatively, 15cc of pus was drained from the endometrial cavity and sent for microbiological examination, which was found to be positive for gram-positive cocci.
Microscopic sections obtained from the tissue received for histopathological examination showed endometrial tissue with few glands and sheets of lipid containing foamy histiocytes in the stroma, along with diffuse infiltration by inflammatory cells (lymphocytes and plasma cells). A few areas of histiocytic aggregates were seen infiltrating the myometrium (Figures 2-5). Ziehl-Neelsen, PAS, and GMS staining revealed no specific organism.
Cervical biopsy revealed acute inflammation with regenerative atypia in the squamous epithelium. However, extensive study of endometrial and endocervical tissue revealed no evidence of malignancy.