case_images: PMC9366398_01
case_images: Magnetic resonance images showing an irregular mass in the cervical area. The irregular mass shadow (3.8 x 1.2 x 2.0 cm) is visible with a thickened and prominent cervical posterior wall. There is suspected penetration of vaginal posterior wall and involvement of the rectum (arrow).
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case_images: f1
case_images: Enhanced pelvic magnetic resonance imaging indicated an 3.8 x 1.2 x 2.0 cm irregular mass in the lower uterine cavity-cervical region with a prominent thickening of the posterior cervical wall; penetration of the posterior vaginal wall with rectal involvement was also suspected (Figure 1).
case_images: Positron emission tomography/computed tomography, showing a mass with fluorodeoxyglucose (FDG) uptake in the cervix (maximum standardized uptake: 10.49).
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case_images: f2
case_images: Gastroscopy was subsequently performed, and pathological examination suggested mild inflammation of the intestinal tract. 18F-fluorodeoxyglucose positron emission tomography/computed tomography indicated increased fluorodeoxyglucose metabolism in the cervix and endometrium with involvement of the lower uterine corpus and vagina (Figure 2).
case_images: Histopathological findings (hematoxylin-eosin staining). Well-differentiated adenocarcinoma of the cervix (A), 100x; (B), 200x and well-differentiated adenocarcinoma of the endometrium (C), 100x; (D), 200x.
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case_images: Postoperative pathology of cervical and endometrial tissue revealed highly differentiated adenocarcinoma consistent with an intestinal epithelial origin ( Figure 3 ).
case_images: Immunohistochemical staining of tumor cells for (A) caudal-related homeobox 2 (positive), (B) carcinoembryonic antigen (positive), (C) cytokeratin (CK) 7 (negative), (D) CK20 (positive). (E) estrogen receptor (negative), (F) Ki-67 (approximately 70% positive), (G) P16 (partially positive), (H) P53 proteins (negative), (I) progesterone receptor (negative), and (J) special AT-rich sequence-binding protein 2 (positive).
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case_images: f4
case_images: AT-rich sequence-binding protein 2; partially positive staining for p16 protein; and negative staining for estrogen receptor, progesterone receptor, p53 proteins, and CK7 ( Figure 4 ). Additionally, the tissues were positive for the mismatch repair proteins MLH1, PMS2, MSH2, and MSH6.