case_images: PMC11303192_01
case_images: Pathologic findings: (A) Non-keratinizing squamous cell carcinoma of the cervix (HEx200), (B) Right ovarian fibroma (HEx200), Immunohistochemistry: (C) (Vimentin x200) positive. (D). (E) Large cell neuroendocrine carcinoma of the cervix (HEx200), Immunohistochemistry: (F) (CD56x200) positive, (G) (SYNx200) partially positive. (H) (EGFR x200) positive.
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case_images: Cervical biopsy: Non-keratinizing squamous cell carcinoma of the cervix ( Figure 1A ). Large cell neuroendocrine carcinoma of the cervix and right ovary ( Figure 1E ), infiltrating the full thickness of the cervix, with vascular and nerve invasion; (cervix and cervical canal, posterior vaginal fornix, part of the uterine body) showed high-grade squamous intraepithelial lesion (HSIL/CIN III) involving glands; margins were tumor-free: cancer nodules found in the perivesical fibrofatty tissue (3 nodules): Immunohistochemistry: CD56 (+) ( Figure 1F ), Syn (partly +) ( Figure 1G ), P16 (+), EGFR (+) ( Figure 1H ), TTF-1 (-), CK5/6 (-), Ki-67 (+, about 70%); 2. Right ovarian fibroma ( Figure 1B ): Vimentin (+) ( Figure 1C ), Inhibin-a (-); 3.
case_images: Abdominal and pelvic enhanced CT: (Before chemotherapy AB After chemotherapy CD) : (A) The pelvic mass presents as an irregular solid cystic lesion measuring 5x6cm, exhibiting patchy shadowing and demonstrating enhancement of both the solid component and cyst wall. ((1)); The cervix exhibited a 5 x 4cm mass with heterogeneous enhancement of soft tissue density. (o(2)); Bilateral ovarian enlargement ((3)), Pelvic effusion. (B) Splenomegaly ((1)); bilateral hydronephrosis with bilateral hydrourete ((2)), Abdominal effusion ((3)). (C) Disappearance of cervical lesion ((1)), In the right adnexal area, the density shadow of irregular soft tissue mass was 4.1 x 4.3cm ((2)). (D) Disappearance of bilateral hydronephrosis ((1)), Splenomegaly, Splenic abscess (5.5x1.7cm) ((2)).
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case_images: Bilateral ovarian enlargement was also noted, raising concern for metastatic disease. ( Figure 2A ); abdominal and pelvic effusion, splenomegaly, bilateral hydronephrosis with bilateral hydroureter ( Figure 2B ); pelvic and left inguinal lymph node metastasis. After four cycles of chemotherapy, a follow-up enhanced CT scan of the pelvis and abdomen showed a significant reduction in the size of the cervical lesion, which was indistinct, a reduction in the left adnexal lesion, which was unclear, and a slight reduction in the right adnexal lesion ( Figure 2C ); a decrease in ascites; the disappearance of bilateral hydronephrosis; splenomegaly, with possible splenic abscess ( Figure 2D ), and a reduction in pelvic and abdominal lymph nodes.
case_images: Tumor markers.
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case_images: Tumor markers ( Figure 3  before chemotherapy). Tumor markers were reassessed ( Figure 3  after chemotherapy).
case_images: Pelvic exenteration was performed to reconstruct organ functions: (A) The proximal segment of the severed ileum was embedded and sutured, (B) The ileocystostomy was fixed, (C) Detach the right rectus muscle flap. (D) A fistula with a diameter of 0.5cm was found in the trigone of the bladder ((1)); The right ovary was enlarged about 4cm in diameter ((2)).
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case_images: Prior to the third cycle of chemotherapy, the patient developed a vesicovaginal fistula resulting in urinary leakage ( Figure 4D ). The stent tubes were fixed to the ureters, the distal end of the ileal pouch, and the skin to prevent dislocation ( Figures 4A, B ). The freed pedicled rectus abdominis muscle was pulled down to the pelvic floor, closing the vaginal stump to promote healing of the vaginal remnant, strengthen the anterior rectal wall to prevent fistula, eliminate pelvic floor space, reduce pelvic effusion, and prevent infection ( Figure 4C ). Postoperative examination of the specimen revealed visible tumor lesions near the urethra close to the bladder and on the posterior wall of the bladder, with a leak point near the anterior urethra in the bladder trigone area ( Figure 4D ).