Serous Carcinoma of Uterine Cervix: A Clinicopathological Dilemma

Primary cervical serous carcinoma was initially described as a morphologically distinct entity resembling serous carcinomas elsewhere in the female genital tract [FGT]. Recently, this histological subtype has been excluded from the latest WHO classification. It is suggested that this entity represents metastasis or extension of a serous carcinoma of the upper genital tract including the fallopian tube, ovary, endometrium, or peritoneum.

To retrospectively review malignancies of female genital tract presenting as serous carcinomas of the uterine cervix.

Electronic medical records of patients diagnosed with serous carcinomas of FGT involving cervix in the department of gynaecologic oncology at a tertiary centre between 2011 and 2023 were reviewed.

There were six women with serous carcinoma of FGT involving the cervix. Mean age was 55 years, and all were postmenopausal. Five patients presented with blood-stained white discharge per vagina. Clinically all patients presented with a proliferative growth on the cervix which was distinct from the regular appearance of squamous cell carcinomas of cervix. None of the patients had ascites/abdominal disease. Histopathologic assessment was suggestive of high-grade serous carcinomas in all the cases. Immunohistochemistry revealed that all the cases were metastatic—four out of six cases being primary endometrial carcinoma and the other two—primary fallopian tube carcinomas. Three out of the six women received neoadjuvant chemotherapy in view of parametrial involvement, and the other three underwent primary debulking surgeries.

Atypical appearance of cervical growth/with serous histology needs thorough evaluation as ascertaining the site of primary origin of the tumour is of utmost importance in planning optimum treatment. All cases of serous carcinoma of cervix included in this study were primaries from upper genital tract. This supports the exclusion of primary cervical serous carcinomas from the 2020 WHO classification.