Carcinoma of the cervix

Early invasive cervical squamous carcinoma - removed by hysterectomy

Image used with permission, Image 1350 from Peir Digital Library – public access image database,
http://peir.path.uab.edu University of Alabama at Birmingham, Department of Pathology

Advanced cervical carcinoma with urinary obstruction - removed at autopsy

Clinical data

• The patient was an elderly woman who presented with post-menopausal bleeding, a foul smelling vaginal discharge, pain in the lower abdomen, dysuria and urinary frequency.
• On vaginal examination a large fungating growth of the cervix was found.
• She was given radiotherapy (palliative) but two weeks later she became mentally confused, then comatose, and died.

At autopsy

• The specimen shows, in the lower half, the bisected uterus and cervix (flapped open) and base of bladder.
• All these are extensively infiltrated by tumour tissue.

• Just above the bladder the right ureter disappears into tumour.
• Both ureters are dilated, the right more so.
• The right kidney is atrophied while the left kidney is enlarged.
• This indicates that obstruction of the right ureter preceded that of the left by a long enough interval to allow some compensatory hypertrophy of the left kidney.

Comment

• Most patients with stage IV carcinoma of the cervix die in uraemia (renal failure) – this is explained by the anatomical proximity of the ureters to the cervix, just before they enter the bladder.
• Advanced cervical carcinomas extend directly into contiguous tissues – vagina, rectum, bladder, ureters, paracervical tissue.
• Obstruction of the ureters by tumour extension causes back pressure on the kidney, with dilatation of the renal pelvis and calyx, and atrophy of the functional renal parenchyma (=hydronephrosis).
• Infection (pyelonephritis) often supervenes.

A useful link

• Run through images 1-15 (covering cervix and vagina) on this WebPath page http://library.med.utah.edu/WebPath/FEMHTML/FEMIDX.html#2