Coexistence of adenoid cystic carcinoma and squamous cell carcinoma of the uterine cervix with HPV 16 infection: clinical course of delayed adjuvant treatment.

Adenoid cystic carcinoma (ACC) is a rare variant of cervical carcinoma and has an aggressive clinical behavior, and there have been few reports of co-existing ACC and squamous cell carcinoma (SCC) of the uterine cervix. A 76-year-old postmenopausal woman presented with vaginal bleeding. The cervical cytology and polypectomy results were SCC, and magnetic resonance imaging (MRI) of pelvis revealed a 2.3 × 1.8 cm sized lobulated mass at the cervix. Microscopically, the tumor showed infiltrative nests of squamoid cells and a cribriform pattern of basaloid cells. Immunohistochemical studies showed that squamous cells were positive for p63 and that basaloid cells were mainly positive for CD117 and S-100 protein. Both components were strongly positive for p16 immunostaining. The tumor was diagnosed as invasive SCC with concurrent ACC. The disease relapsed after a follow-up of 14 months with no adjuvant therapy. Subsequently, she received concurrent chemoradiotherapy (CCRT) and then combined chemotherapy with paclitaxel, cisplatin, and bevacizumab; finally, imaging revealed no evidence of residual cancer.