A case of primary (de novo) carcinoma of the uterine cervix after cadaveric orthotopic liver transplantation
Zafer Teke, Erdal Birol Bostancı, Murat Ulaş, Musa Akoğlu
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, Ankara, Türkiye
Organ transplant recipients carry a greater risk for developing de novo malignancies. Recurrent or de novo malignancies are the second leading causes of late death in liver transplant recipients, following infectious complications. A high incidence of posttransplantation lymphoproliferative disease, skin carcinomas, Kaposi's sarcoma, and uterine cervical dysplasia has been reported after solid organ transplantations. A 46-year-old female had undergone cadaveric orthotopic liver transplantation for chronic hepatitis B-induced liver cirrhosis. During a routine gynaecological examination 19 months posttransplantation, she received a Pap smear which was positive for a high-grade squamous intraepithelial lesion, and then she underwent colposcopic cervical biopsy which was positive for squamous cell carcinoma. Subsequently, a radical hysterectomy (Wertheim's procedure) was performed by the gynaecological oncology clinic. Histopathological examination of the resected specimen showed the uterus to be positive for large-cell keratinizing squamous cell carcinoma of the cervix. The disease stage was IIIb. Thereafter, she underwent adjuvant chemotherapy with cisplatin, and received external-beam radiation to the pelvis and intracavitary brachytherapy to the vaginal cuff. The patient was then evaluated at every 3 months, with gynaecological examinations in terms of the response to treatment, and a complete pathological response was achieved. The whole-body positron emission tomography was conducted with 18F-fluorodeoxyglucose, and there was no increased uptake at any site. The patient was all doing well at 33 months posttransplantation and 14 months after radical gynaecological surgery. Female patients with liver transplantation need continuous surveillance for cervical cancer with annual screening Pap smears and pelvic exam. In high-risk liver transplant recipients for developing gynaecological malignancies (those with prior malignancy or predisposing underlying disease), aggressive surveillance including colposcopy should be employed.
Keywords: Liver transplantation, cancer of the uterine cervix, tacrolimus, cervical smear