case_images: PMC10864126_01
case_images: Preoperative imaging studies and laparoscopic surgery. (A and B) Magnetic resonance image (T2 image) acquired after drainage. (A) A small amount of fluid was retained in the uterine cavity. (B) The arrow shows a lesion on the left wall of the uterine body with a pale high-signal. This lesion is high-signal on diffuse-weighted imaging and its apparent diffusion coefficient is low (not shown). (C) Computed tomography performed on the day before surgery. The uterus was enlarged with hematometra. (D and E) Laparoscopic surgery. (D) The small intestine was adherent to the abdominal wound. (E) Enlarged uterus. Pelvic peritoneal dissemination was not observed.
case_images: cureus-0016-00000052271-i01.jpg
case_images: PMC10864126_01_cureus-0016-00000052271-i01.jpg
case_images: FIG1
case_images: Pelvic magnetic resonance imaging (MRI) after puncture drainage revealed a small amount of fluid retention in the uterine cavity (Figure 1A) and a 1 cm lesion on the left wall of the uterine myometrium suspicious of uterine malignancy (Figure 1B). However, increasing fluid accumulation in the uterine cavity, as shown by CT examination (Figure 1C), caused abdominal pain. The small intestine showed extensive adhesions to the abdominal wall (Figure 1D), which were dissected. Because of the dense adhesions of the small intestine and rectum to the uterus (Figure 1E), the cervical opening was dilated, and brown-red fluid was drained from the uterine cavity to obtain a better surgical view.
case_images: Macroscopic and microscopic findings of the uterus. (A) Macroscopic findings of the morcellated pieces of the uterine body after formalin fixation. (B) Hematoxylin and eosin (H&E) staining, magnification x1.25. Nests of squamous cell carcinoma in the uterine myometrium. There was no apparent endometrium (at the bottom side of the figure). (C) H&E staining, magnification x10. Squamous cell carcinoma, non-keratinizing type. (D) Immunohistochemical staining for p16. Diffuse nuclear and cytoplasmic staining of squamous cell carcinoma.
case_images: cureus-0016-00000052271-i02.jpg
case_images: PMC10864126_01_cureus-0016-00000052271-i02.jpg
case_images: FIG2
case_images: The uterine corpus was fragile with no macroscopic lesions in the endometrium, and the cervix was not visible (Figure 2A). Histopathological examination revealed nests of squamous cell carcinoma that replaced the full layer of the entire uterine myometrium without the involvement of the serosa (Figures 2B, 2C). Histopathology showed no endometrial involvement, and the tumor cells showed diffuse positivity for p16 on immunostaining (Figure 2D).
case_images: Computed tomography and microscopic findings of the disseminated lesions. (A and B) Computed tomography performed on the day of the bypass surgery. (A) The arrows show tumors. (B) Small bowel obstruction and bilateral hydronephrosis. (C) H&E staining of the biopsied tumors, magnification x4. Squamous cell carcinoma. (D) Immunohistochemical staining of p16 in the biopsied tumor.
case_images: cureus-0016-00000052271-i03.jpg
case_images: PMC10864126_01_cureus-0016-00000052271-i03.jpg
case_images: FIG3
case_images: CT showed many mesenteric masses (Figure 3A) that had not been detected on the CT performed two weeks earlier. Bilateral hydronephrosis and lower ureteral stenosis were suspected (Figure 3B). A biopsy of a disseminated lesion near the vaginal cuff revealed squamous cell carcinoma (Figures 3C, 3D).