Scholars Journal of Medical Case Reports

Abbreviated Key Title: Sch J Med Case Rep

ISSN 2347-9507 (Print) | ISSN 2347-6559 (Online)
Journal homepage: https://saspublishers.com Oncology-Radiotherapy

Clear Cell Adenocarcinoma of the Young Woman's Cervix: About A Case

Safemba Ibrahim Rachid Soulama1*, Alice Wendpanga Sorgho1, Anis Agouzzal1, Mouna Darfaoui1, Abdelhamid
Elomrani1, Mouna KHouchani1
1Oncology-Radiotherapy Department – Oncology-Hematology Center – Mohammed VI University Hospital Marrakech, Morocco

DOI: 10.36347/sjmcr.2023.v11i10.003 | Received: 21.08.2023 | Accepted: 30.09.2023 | Published: 03.10.2023

*Corresponding author: Safemba Ibrahim Rachid Soulama

Oncology-Radiotherapy Department – Oncology-Hematology Center – Mohammed VI University Hospital Marrakech, Morocco

Abstract Case Report

This report presents a case study of a patient diagnosed with clear cell adenocarcinoma of the cervix without a history
of in utero exposure to diethylstilbestrol (DES). It is important to note that despite being an uncommon occurrence, clear
cell adenocarcinoma should be considered a potential diagnosis for young women with cervicovaginal lesions, even if
they have no prior history of in utero DES exposure. We present a case report of a 33-year-old woman who sought
medical attention for menometrorrhagia, leucorrhoea, and the discovery of a vegetative tumour. The patient was
diagnosed with clear cell carcinoma of the cervix. The patient was treated with concurrent radiochemotherapy combined
with endocavitary uterovaginal brachytherapy and showed a favorable progression during a six-month follow-up period.
Keywords: Clear cell adenocarcinoma, cervix, young woman, chemoradiotherapy.
Copyright © 2023 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original
author and source are credited.

I. INTRODUCTION department of the Mohammed VI University Hospital in

Clear cell adenocarcinoma (CCAC) of the Marrakech.
cervix is a rare disease that accounts for only 4% of all
adenocarcinomas of the cervix [6]. Its etiology and II. CASE REPORT
pathogenesis are not yet clear. Several studies have This is a young patient of 33 years, married
linked the occurrence of cervical or vaginal CCAC in mother of 4 children, without particular history who
young women to intrauterine exposure to presented to her gynecologist for leucorrhoea and meno-
diethylstilbestrol (DES), a synthetic nonsteroidal metrorrhagia. The gynecological examination finds a 7
estrogenic hormone prescribed to pregnant women in cm vegetative tumor infiltrating the vagina. The
several countries as a preventive therapy against abortion pathological study of the cervical biopsy revealed
[4, 5]. On the other hand, many cases of cervical or invasive clear cell adenocarcinoma. A pelvic MRI was
vaginal CCAC have been reported in young women with performed objectifying a lesional process centered on the
no history of intrauterine exposure to DES [1]. cervix extended to the isthmian region (Fig 1a, b)
measuring 5.7x7.3x5.8 cm infiltrating two-thirds of the
CCAC often manifests as irregular vaginal vagina at the bottom pushing back the rectum with
bleeding. In young adult women who have irregular respect for the fatty border of separation and integrity of
bleeding, the possibility of a vaginal or cervical tumor the rectovaginal septum, in front it pushes back the
should be considered in the differential diagnosis [7]. bladder with respect for the separation border; discreetly
The most important prognostic factors for CCAC are infiltrating the parameters bilaterally that can be
stage, tumour size and lymphovascular invasion. The classified FIGO IIB. An extension assessment made of a
most common extra-pelvic sites of relapse are the lung, thoraco-abdomino-pelvic CT scan was performed,
liver and bones. CCAC also has a lower 5-year survival revealing no secondary location.
rate than carcinomas epidermoids [8]. Due to the low
incidence of CCAC, there are limited data on clinical The patient was treated with concurrent
behaviour, disease characteristics, optimal management, radiochemotherapy of 45 Gy in 25 fractions of 1.8 Gy in
patterns of metastasis and recurrence. We report the case combination with endocavitary uterovaginal
of a young woman who has clear cell adenocarcinoma of brachytherapy of 7 Gy x 4. At six months follow-up, the
the cervix followed at the oncology-radiotherapy disease had not progressed.

Citation: Safemba Ibrahim Rachid Soulama, Alice Wendpanga Sorgho, Anis Agouzzal, Mouna Darfaoui, Abdelhamid
Elomrani, Mouna KHouchan. Clear Cell Adenocarcinoma of the Young Woman's Cervix: About A Case. Sch J Med Case 1733
Rep, 2023 Oct 11(10): 1733-1735.
 Safemba Ibrahim Rachid Soulama et al, Sch J Med Case Rep, Oct, 2023; 11(10): 1733-1735

Fig 1a, b: Magnetic resonance imaging (MRI) showed a lesional process centered on the cervix extended to the
isthmian region measuring 5.7x7.3x5.8 cm infiltrating two-thirds of the vagina at the bottom pushing back the
rectum with respect for the fatty border of separation and integrity of the rectovaginal septum, in front it pushes
the bladder with respect for the border of separation. a Transverse. b Sagittal

III. DISCUSSION chemotherapy and radiotherapy, and if patients have

In recent years, there has been an increase in the undergone surgery, it is associated with a higher risk of
frequency of cervical adenocarcinomas, mainly due to a complications. In our patient, we did not perform surgery
decrease in invasive squamous cell carcinomas in because of her advanced stage radiochemotherapy was
countries where cervical neoplasia screening has been decided chemotherapy of choice is usually cisplatin
effectively implemented. combined with radiotherapy. One study also suggested
that there was increased activation of the EGFR-PI3K-
CCAC is a rare tumour, which usually occurs in AKT-mTOR pathway in CCAC and that tyrosine kinase
young women. Hanselaar et al reported that the CCAC and AKT-mTOR inhibitors could be novel therapeutic
has a bimodal age distribution. The first peak in average targets [3].
age was 26 years (17 to 37), and the second was 71 years
(44 to 88) [1]. Contrary to these results, in a study IV. CONCLUSION
conducted by Seki et al., [9] involving 32 Japanese CCAC remains a rare disease without exposure
patients, CCAC was observed in all age groups (mean to DES. In the absence of clear guidelines for the
age 50.8 years). The youngest case of clear cell vaginal management of CCAC, more randomised controlled
carcinoma reported in the literature was a one-year-old trials are needed to find the appropriate treatment
child [8]. regimen. But the rarity of the condition could prove to be
a challenge in conducting large-scale trials.
In utero exposure to DES was a known
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© 2023 Scholars Journal of Medical Case Reports | Published by SAS Publishers, India 1735