Definition/General
Introduction:
Cervical inflammatory carcinoma is a rare and aggressive clinical variant of cervical carcinoma characterized by rapid onset, diffuse cervical enlargement, and extensive lymphovascular invasion
It mimics inflammatory conditions clinically.
Origin:
May arise from any histological type of cervical carcinoma (squamous cell carcinoma or adenocarcinoma) but shows characteristic pattern of extensive lymphovascular invasion.
Classification:
Classified based on underlying histological type (squamous or glandular) but designated as inflammatory variant due to clinical presentation and extensive vascular involvement.
Epidemiology:
Extremely rare representing <1% of cervical carcinomas
Peak incidence 35-55 years
Associated with HPV infection
Highly aggressive with poor prognosis.
Clinical Features
Presentation:
Rapid onset cervical enlargement
Diffuse cervical induration
Erythema and edema of cervix
May mimic acute cervicitis or pelvic inflammatory disease.
Symptoms:
Profuse vaginal bleeding
Foul-smelling discharge
Pelvic pain
Fever (may be present)
Rapid clinical deterioration
Urinary retention.
Risk Factors:
HPV infection (high-risk types)
Previous cervical dysplasia
Immunosuppression
Smoking
Multiple sexual partners
Poor access to screening.
Screening:
Often advanced at presentation
Pap smear may show malignant cells
Clinical examination reveals indurated, enlarged cervix
Biopsy mandatory for diagnosis.
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Gross Description
Appearance:
Diffusely enlarged, indurated cervix
Surface may be ulcerated or necrotic
Edematous and hemorrhagic appearance
Loss of normal cervical architecture.
Characteristics:
Cervix typically >5 cm
Hard, woody consistency
Red to purple discoloration
Extensive necrosis may be present
Friable tissue.
Size Location:
Involves entire cervix diffusely
Extension to parametrium common
Vaginal involvement frequent
May involve corpus uteri.
Multifocality:
Diffuse involvement by definition
Multiple areas of vascular invasion
Early metastatic spread common
Widespread disease typical.
Microscopic Description
Histological Features:
Extensive lymphovascular invasion is the defining feature
Underlying carcinoma may be squamous or adenocarcinoma
Dermal lymphatic-like pattern of invasion.
Cellular Characteristics:
Cellular features depend on underlying carcinoma type
High-grade nuclear features typical
Abundant mitotic activity
Necrosis common.
Architectural Patterns:
Characteristic extensive lymphovascular invasion
Tumor emboli in numerous vessels
Underlying invasive carcinoma
Stromal edema and inflammation.
Grading Criteria:
Usually high-grade by definition due to aggressive behavior
Grading based on underlying carcinoma type
Extensive vascular invasion noted.
Immunohistochemistry
Positive Markers:
Markers depend on underlying carcinoma
Squamous: p63+, CK5/6+
Adenocarcinoma: CK7+, CEA+
Vascular markers highlight invasion (CD31, CD34).
Negative Markers:
Markers negative based on underlying type
Lymphoid markers negative
Melanoma markers negative.
Diagnostic Utility:
Vascular markers (CD31, CD34) highlight extensive lymphovascular invasion
p16 may be positive if HPV-associated
Confirms carcinomatous nature.
Molecular Subtypes:
HPV-associated in most cases
Molecular features similar to underlying carcinoma type
Complex genetic alterations likely present.
Molecular/Genetic
Genetic Mutations:
HPV integration common
p53 mutations frequent
PIK3CA alterations
KRAS mutations
Extensive chromosomal instability typical.
Molecular Markers:
HPV DNA detectable
p16 overexpression
Loss of p53 function
Very high Ki-67 proliferation index (>70%)
Angiogenic markers elevated.
Prognostic Significance:
Extremely poor prognosis
Median survival <12 months
Extensive vascular invasion predicts rapid dissemination
Stage at presentation crucial.
Therapeutic Targets:
Limited effective therapies
Anti-angiogenic agents theoretical target
Immune checkpoint inhibitors under investigation
Aggressive multimodal therapy required.
Differential Diagnosis
Similar Entities:
Acute cervicitis
Pelvic inflammatory disease
Cervical abscess
Conventional cervical carcinoma with infection
Lymphoma
Metastatic carcinoma.
Distinguishing Features:
Inflammatory carcinoma: Malignant cells in vessels, rapid progression
Cervicitis: Inflammatory cells only, responds to antibiotics
Lymphoma: Lymphoid markers positive.
Diagnostic Challenges:
Clinical mimicry of infectious process
May be misdiagnosed as PID initially
Requires high index of suspicion
Extensive sampling needed.
Rare Variants:
Squamous cell type most common
Adenocarcinoma type less common
Mixed histologies possible
Secondary inflammatory changes.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type] showing diffuse enlargement, measuring [size] cm
Diagnosis
Cervical inflammatory carcinoma, [underlying type]
Classification
Classification: [Squamous cell carcinoma/Adenocarcinoma], inflammatory variant
Histological Features
Shows [underlying carcinoma] with extensive lymphovascular invasion
Size and Extent
Size: [X] cm, extent: diffuse cervical involvement
Margins
Margins: [typically involved due to extensive disease]
Lymphovascular Invasion
Lymphovascular invasion: Extensive (defining feature)
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [markers confirming carcinoma type]
Vascular markers: Highlight extensive invasion
[other study]: [result]
Prognostic Factors
Prognostic factors: Poor prognosis due to extensive vascular invasion
Final Diagnosis
Final diagnosis: Cervical inflammatory carcinoma, [type], extensive lymphovascular invasion