Endometrioid endocervical adenocarcinoma in a postmenopausal woman: a case report and review of the literature

Introduction and Importance: Endometrioid adenocarcinoma of the uterine cervix is rare and difficult to distinguish from endometrial adenocarcinoma. It has been referred to as a diagnostic challenge, particularly due to rare endometrioid subtypes that can mimic endometrial carcinoma and are associated with a poorer prognosis. This report presents a case of rapidly progressing endometrioid adenocarcinoma to emphasize this unusual clinical course. Case Presentation: The 62-year-old patient (G2P2) with an unremarkable medical history presented with asymptomatic endometrial fluid detected on routine ultrasound. Subsequent workup, including fractional curettage and MRI, revealed cervical cancer, which was staged as FIGO IB1. The patient underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, with final pathology revealing moderately differentiated endocervical adenocarcinoma (ECA) invading the endocervical canal and uterine isthmus, and negative lymph nodes. The patient had an uneventful postoperative recovery and remains disease-free at 6 months of follow-up. Clinical Discussion: This case highlights the diagnostic difficulty of endometrioid ECA, a rare non-HPV-associated subtype often misidentified as endometrial carcinoma. Rapid progression despite negative cytology underscores Pap smear limitations for glandular lesions. Early radical surgery with adjuvant therapy and multidisciplinary evaluation remain essential for optimizing patient outcomes. Conclusion: The diagnosis of endometrioid ECA is challenging due to its rarity, and determining the tumor's origin remains particularly difficult. Furthermore, the phenomenon of "rapid-onset" cervical carcinoma, often an adenocarcinoma, warrants attention because Pap smears have lower sensitivity for detecting glandular lesions than squamous lesions.