The patient, a 28-year-old woman, has been sexually active with multiple partners since she was 14 years old. She is now married and wants to have children. She has intermittent breakouts of vulvar ulcers/sores but no other complaints. Her pelvic examination during a routine visit with her gynecologist was normal. She had a lump in her left breast.
Studies Results Sexually transmitted infections (STIs), p. 756 Herpes simplex test, p. 731 Positive for herpes simplex virus-2 (HSV-2) (normal: negative) No change in serology 4 weeks later Cytomegalovirus, p. 200 No antibodies detected Chlamydia, p. 722 No antibodies detected Gonorrhea, p. 761 Culture negative Syphilis serology, p. 473 No antibodies detected Pap smear, p. 743 Adequacy of specimen Adequate Category Epithelial abnormality Epithelial cell abnormalities Squamous, atypical cells Human papillomavirus (HPV) testing, p. 745 Positive for HPV 16 Breast sonogram, p. 871 Benign fibroadenoma
Diagnostic Analysis
The patient was informed of her test results. Her herpes titers indicated that the disease was rather chronic, not acute. No treatment was recommended. Because of her age, mammograms were contraindicated. A breast ultrasound indicated the lesion was not cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV results and suspicious Pap smear, further evaluation was recommended.
Studies Results Colposcopy, p. 595 Several suspicious areas Biopsy Squamous cell carcinoma Cervical cone biopsy, p. 720 Invasive squamous cell carcinoma Hysteroscopy, p. 614 No extension to the endocervical canal or uterus Pelvic ultrasound, p. 887 No extension of tumor beyond the cervix The patient was advised to have a radical hysterectomy. She refused because she wanted to have a family. She began psychologic counseling for guilt over her past promiscuity, which had increased her risk for cervical cancer. She became pregnant 1 year later and lost the
Case Studies 2 pregnancy during the second trimester. One year later, she developed a large pelvic mass, which represented progressive, inoperable cervical cancer. Despite radiation therapy and chemotherapy, she died at age 31 of cervical cancer.
Critical Thinking Questions
- Why was mammography contraindicated for this patient? 2. How is sexual promiscuity related to the risk for cervical cancer?