Analysis of missed diagnosis and misdiagnosis of 13 cases with gastric-type endocervical adenocarcinoma
Objective To analyze the clinical features and diagnostic history of gastric-type endocervical adenocarcinoma(G-EAC),summarize the causes of missed diagnosis and misdiagnosis,and provide help for early diagnosis of the disease.Methods The basic case data of 13 G-EAC patients diagnosed by pathology and with missed diagnosis and misdiagnosis in Maternal and Child Health Hospital of Hubei Province from December 2016 to February 2023 were collected for retrospective analysis,and the causes of missed diagnosis and misdiagnosis were summarized.Results There were 8 cases(61.5%)with vaginal discharge,4 cases(30.8%)with vaginal bleeding,and 1 case with abnormal echogenicity of the cervical canal detected by ultrasound;9 cases(69.2%)had normal cervical appearance,3 cases had cauliflower-like cervix,and 1 case had cervical mass.HPV test was performed in9 patients and the results were all negative;TCT was performed in 9 patients,6 of them(66.7%)were abnormal.7 cases were examined by tumor markers,CA199 was elevated in 4 cases(57.1%),CA125 was elevated in 4 cases(57.1%),and carcinoembryonic antigen(CEA)was elevated in 3 cases(42.9%).Cervical echo was changed in 5 cases(38.5%)of 13 cases undergoing pelvic ultrasound;MRI was performed in10 patients,and7 of them(70.0%)suggested cervical malignancy.The initial diagnosis was misdiagnosed as vaginitis in 7 cases(53.8%),ovarian cyst in 1 case,hemorrhoids in 2 cases,abnormal uterine bleeding in 2 cases,and cervical polyp in 1 case,with a delayed diagnosis time of 5 days to 3 years.The final diagnosis was confirmed by cervical biopsy or diagnostic scraping in 9 cases(69.2%),and 4 cases(30.8%)were confirmed by postoperative pathology.5 cases died from 4 to 34 months of follow-up,7 cases survived from 1 to 24 months of follow-up,and 1 case was in hospital.Conclusion G-EAC is rare clinically and has atypical symptoms and well differentiated tissues,so it is easy to be missed and misdiagnosed.Clinicians need to enhance their knowledge of the disease,pay attention to patients'complaints and gynecologic ultrasound examinations,tumor marker were detected in suspicious patients,and actively perform multi-point cervical biopsy or even cervical conization;pathologists need to enhance their knowledge of the disease and pay attention to immunohistochemical examinations to improve the diagnosis rate.
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