S2253 An Unusual Case of Cervical Cancer Diagnosed by Colonoscopy

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Introduction: Cervical cancer is the fourth most common neoplasm and fourth leading cause of cancer death amongst women worldwide. We present an unusual case of cervical cancer diagnosed by colonoscopy. Case Description/Methods: A 52-year-old Hispanic woman with a history of remote stage IIB squamous cell carcinoma of the cervix diagnosed 8 years prior and treated with radiation and chemotherapy presented to the outpatient gastroenterology clinic with 10 months of intermittent hematochezia and changes in bowel habits. She reported rectal bleeding with mucus, passing stool through her vagina, and fecal urgency without constitutional symptoms. She had no prior colonoscopy and has no family history of gastrointestinal malignancy. Colonoscopy was performed and was notable for an infiltrative and ulcerated mass in the anterior wall of the proximal rectum measuring approximately 5 cm in length. Histological examination revealed poorly differentiated squamous cell carcinoma with malignant cells positive for CK5, CK6, p63, and p16 and negative for CK7, CK20, PAX8, SOX10 and CDX2, favored to represent a cervical origin. Pelvic MRI confirmed an irregular enhancing 4 x 5 x 4 cm mass, locally invasive to the rectum. She was referred to Gynecologic Oncology, where she was initiated on combination chemotherapy and immunotherapy. Discussion: We report a unique case of cervical cancer recurrence diagnosed by colonoscopy. Diagnosis of cervical cancer customarily is made by Papanicolaou smear cytology and human papillomavirus (HPV) testing in conjunction with pelvic imaging. Cervical cancer can infiltrate adjacent organs such as the peritoneum, bladder, vagina, ureters, rectum and, rarely, the small intestine and the sigmoid colon. Cervical cancer diagnosis during colonoscopy is highly unusual and, to our knowledge, has only been reported in 3 cases in the literature. All reported instances represented recurrence after definitive management with hysterectomy and presented with hematochezia and/or abdominal pain. Our patient presented with hematochezia as well as with passage of stool through the vagina, a unique gestalt in an already uncommon clinical scenario. We recommend that general practitioners and gastroenterologists bear in mind gynecologic malignancy infiltrating the colon in women with the appropriate clinical history and colonoscopy findings given the intimate proximity of these organ systems.

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