Here, we report a successful case following the treatment of a patient with pure CABCC. She did not exhibit typical clinical symptoms of cervical cancer, such as bleeding, abnormal vaginal discharge, or pain. Moreover, no cervical mass was detected during the gynecological examination conducted by experienced gynecologists. After a cervical biopsy and LEEP surgery, laparoscopic hysterectomy and bilateral adnexectomy were performed. The pathological diagnosis confirmed CABCC, and no other pathological cancer types were found. All resection margins were clean, and no evidence of vascular or lymphatic space invasion (LVSI) was observed. Subsequent postoperative follow-up did not reveal any residual vaginal cytology lesions.
In 2014, CABCC was named by the Female Genital Oncology organization within the WHO (8). CABCC accounts for less than 1% of all cervical malignancies, and only a limited number of cases have been reported in China (9). Patients with pure CABCC are asymptomatic, they do not exhibit definite cervical masses during routine gynecological physical examinations or colposcopies. Besides, they hardly experience vaginal bleeding and abnormal vaginal discharge, while patient s with CABCC accompanied by other pathological type of cervical carcinoma will do (10). HPV infection may be linked to the development of CABCC with other pathological type of cervical cancer (11). We have collected 11 cases with CABCC reported before by Zhan Li and his team(12), and as illustrated in Fig. 4, the pathological results of majority proved to be other types of cancer accompanied with CABCC, and most of them had HPV infection. It can be concluded that CABCC may be related to HPV infection. Generally speaking, in clinical work, patients with pure CABCC do not have obvious clinical symptoms, but many people had been infected by cervical HPV, which means routine HPV smear plays a crucial role in early discovery and early treatment.
CABCC is characterized by specific histological features, which means that it is identified based on how the cancer cells appear under a microscope when examined by a pathologist. These histological characteristics are essential for confirming the diagnosis of CABCC. Here are some of the key histological features of CABCC: CABCC often displays a glandular or tubular growth pattern, where the cancer cells form small, round, or elongated structures that resemble glandular or tubular formations(13). These structures can be observed when cervical tissue samples are examined under a microscope. The cancer cells in CABCC are typically described as basaloid, meaning they resemble the cells found in the basal layer of the skin or epithelial tissue. These cells are often small, uniform, and densely packed (14). In some cases, CABCC may exhibit a histological feature known as peripheral palisading. This refers to the arrangement of cells at the periphery of tumor nests in a linear or palisade-like fashion. While the nuclei of CABCC cells are usually uniform, they can sometimes show mild to moderate nuclear atypia, which means there may be some irregularity in the size or shape of the cell nuclei. CABCC can also be associated with stromal desmoplasia, which refers to the formation of fibrous tissue in the tumor stroma. This desmoplastic reaction is a characteristic feature of CABCC (15). Pathologists play a significant role in accurately diagnosing CABCC by examining tissue samples obtained through biopsy and assessing the specific histological features that distinguish it from other cervical lesions and cancers. The histological diagnosis is a critical step in determining the appropriate treatment and management plan for individuals with this rare form of cervical cancer (16).
Pure CABCC is a low-grade malignant tumor with indolent biological behavior and a good prognosis. Cervical conization, cervical resection, hysterectomy and unilateral (or bilateral) adnexectomy can be used as treatment methods. For women of childbearing age who have reproductive requirements, if only combined with CIN or simple ABC, LEEP or cervical conization can be used. For postmenopausal women, in order to avoid the possibility of unclean resection of deep lesions in conization, total hysterectomy and adnexectomy can be considered (17). Adjuvant chemoradiotherapy is not required after surgery, but close follow-up is required. For patients with ABC combined with other malignant tumors, the treatment method and prognosis evaluation depend on the histological type, clinical stage, and grade of the combined tumor (18). In conclusion, pure CABCC is an extremely rare form of cancer, and there is limited clinical information available about it due to its infrequent. It is often found during physical examination because patients are always asymptomatic. Diagnosis of CABCC typically involves a combination of methods, including a clinical examination, imaging studies (such as ultrasound or MRI), and a biopsy of the cervical tissue to confirm the presence of cancer (19). The specific treatment plan depends on factors like the stage of the cancer and the patient's overall health. It's important to note that risk factors for cervical CABCC are not well-established due to its rarity (20). However, like other cervical cancers, it may be associated with risk factors such as human papillomavirus (HPV) infection and certain lifestyle and genetic factors(21). As a result, routine HPV smear is of great importance to early detection and treatment.