HPV-Bağımsız Gastrik Tip Endoservikal Adenokarsinomun Multimodal Tedavisi Sonrasında Nüksü Taklit Eden Yanlış Pozitif Vajinal Kaf PET/BT Bulgusu: Bir Olgu Sunumu

Abstract

Amaç: HPV’den bağımsız gastrik tip endoservikal adenokarsinomun (GEA) multimodal tedavisi sonrasında nüksü taklit eden yalancı pozitif vajen kafı pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) bulgusunu sunmak ve görüntüleme ile histopatolojik bulgular arasındaki uyumsuzluğun değerlendirilmesini tartışmaktır.

Yöntem: Üçüncü basamak bir jinekolojik onkoloji kliniğinde izlenen hastanın klinik kayıtları, ameliyat notları, histopatoloji ve görüntüleme raporları incelenerek olgu sunumu hazırlandı. Tedavi kararları multidisipliner tümör konseyinde alındı ve anonim yayın için hastadan yazılı bilgilendirilmiş onam alındı.

Bulgular: ASC-H sitolojisi ve yüksek riskli HPV pozitifliği bulunan 55 yaşındaki hastanın LEEP materyalinde HPV’den bağımsız, gastrik tip lehine endoservikal adenokarsinom saptandı. Radikal histerektomi ve cerrahi evreleme sonrasında kesin patolojide 2,3 cm GEA, 10 mm kalınlığındaki serviks duvarında 9 mm stromal invazyon, lenfovasküler alan invazyonu ve korpus uzanımı izlendi. Parametriyumlar, cerrahi sınırlar ve lenf nodları negatifti; evre pT1b2 pN0, FIGO 2018 IB2 olarak belirlendi. Adjuvan kemoradyoterapi ve vajinal brakiterapi tamamlandı. İzlemde üç ayrı seansta alınan vajen kafı biyopsileri benign tedavi sonrası değişiklikler gösterdi; pelvik manyetik rezonans görüntülemede nüks lehine lezyon saptanmadı. Radikal cerrahiden yaklaşık 15 ay sonra yapılan PET/BT’de sağ vajen kafının hemen inferiorunda yeni fokal FDG tutulumu izlendi (SUVmax 5,8). Önceki biyopsilerin bu PET/BT incelemesinden önce alınmış olması ve devam eden klinik şüphe nedeniyle multidisipliner değerlendirme sonrası laparoskopik vajinektomi uygulandı. Eksizyon materyalinde aktif kronik inflamasyon, kanama odakları ve fibrolipomatöz doku izlendi; rezidü veya nüks karsinom saptanmadı.

Sonuç: Multimodal tedavi sonrası izole vajen kafı FDG tutulumu tek başına nüks tanısı koydurmaz. Radikal kurtarma tedavisi veya nükse yönelik sistemik tedavi öncesinde, mümkün olduğunda histopatolojik doğrulama sağlanmalıdır. Bulgular uyumsuz olduğunda ileri örnekleme veya eksizyon kararı multidisipliner değerlendirmeyle bireyselleştirilmelidir.

Keywords

• Adenokarsinom
• uterin servikal neoplaziler
• pozitron emisyon tomografi bilgisayarlı tomografi
• yalancı pozitif sonuçlar
• lokal neoplazm nüksü
• vajina

A False-Positive Vaginal Cuff PET/CT Finding Mimicking Recurrence After Multimodal Treatment of HPV-Independent Gastric-Type Endocervical Adenocarcinoma: A Case Report

Abstract

Objective: To describe a false-positive vaginal cuff positron emission tomography/computed tomography (PET/CT) finding mimicking recurrence after multimodal treatment of HPV-independent gastric-type endocervical adenocarcinoma (GEA), and to discuss the assessment of discordant imaging and histopathological findings.

Methods: This case report was reconstructed from clinical records, operative notes, histopathology reports, and imaging reports from a tertiary gynecologic oncology unit. Treatment decisions were made by a multidisciplinary tumor board, and written informed consent was obtained for anonymized publication.

Results: A 55-year-old woman with ASC-H cytology and positive high-risk HPV testing underwent loop electrosurgical excision showing HPV-independent endocervical adenocarcinoma favoring gastric type. Following radical hysterectomy and surgical staging, final pathology demonstrated a 2.3-cm GEA with 9-mm stromal invasion in a 10- mm cervical wall, lymphovascular space invasion, and corporeal extension. The parametria, surgical margins, and lymph nodes were negative, establishing pT1b2 pN0, FIGO 2018 stage IB2 disease. Adjuvant chemoradiotherapy and vaginal brachytherapy were completed. During surveillance, three separate vaginal cuff biopsy sessions showed benign post-treatment changes, and pelvic magnetic resonance imaging revealed no lesion suggestive of recurrence. Approximately 15 months after radical surgery, PET/CT demonstrated new focal FDG uptake immediately inferior to the right vaginal cuff (SUVmax 5.8). Because the previous biopsies predated this PET/CT examination and clinical concern persisted, laparoscopic vaginectomy was performed after multidisciplinary assessment. Excision showed active chronic inflammation, hemorrhagic changes, and fibrolipomatous tissue, without residual or recurrent carcinoma.

Conclusion: Isolated vaginal cuff FDG uptake after multimodal treatment does not establish recurrence. Histopathological confirmation should be obtained whenever feasible before radical salvage treatment or systemic therapy for presumed recurrence. When findings remain discordant, further sampling or excision should be individualized through multidisciplinary assessment.

Keywords

• Adenocarcinoma
• uterine cervical neoplasms
• positron emission tomography computed tomography
• false positive reactions
• neoplasm recurrence local
• vagina

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