Clinical Analysis of Cervical HSIL with Poorly Differentiated Squamous Cell Carcinoma Metastatic to the Ovary

Abstract

History summary: A 64-year-old female patient presented with a three-month history of right lower abdominal pain. Ultrasound examination revealed a mass measuring approximately 5 cm × 4 cm × 4 cm in the right adnexal region, which was movable with slight tenderness. The ultrasound suggested a cystic-like mass in the right adnexal region, and “pelvic mass” was considered. Family history: The patient’s mother died of “ovarian cancer” (specific pathological type unknown), and her sister was diagnosed with “breast cancer” (positive for BRCA1 gene testing). Symptoms and signs: The patient experienced dull pain in the right lower abdomen accompanied by a slight sensation of fullness in the lower abdomen. On bimanual examination, a mass measuring approximately 5 cm × 4 cm × 4 cm was palpable in the right adnexal region, which was movable with slight tenderness. Diagnostic methods: Ultrasound suggested a cystic-like mass in the right adnexal region. CT examination revealed a low-density mass in the right adnexal region with slight thickening of the adjacent intestinal wall, suggesting an ovarian origin. Treatment: Laparoscopic total hysterectomy + bilateral adnexectomy + pelvic and para-aortic lymph node dissection + omentectomy + peritoneal multi-point biopsy. Final diagnosis: Pathological consultation at a superior hospital confirmed (cervical) HSIL (CINII grade) and poorly differentiated squamous cell carcinoma of the ovary (metastatic origin). The patient was considered to have poorly differentiated squamous cell carcinoma associated with HPV infection originating from the cervix and metastasizing to the right ovary.