Adenosquamous carcinoma of the cervix: a case report from a resource-limited setting

Abstract

Introduction and importance: Adenosquamous carcinoma of the cervix (ASCC) is a rare, aggressive histological variant representing 1.8% to 5% of cervical malignancies. It is generally associated with a poorer prognosis than squamous cell carcinoma. In resource-limited settings, systemic barriers often preclude standardized multimodal management, necessitating management decisions shaped by limited resources. This case is presented following the SCARE criteria. Case presentation: A 64-year-old multiparous female presented to a tertiary hospital in Uganda with a multi-month history of dyspareunia and post-coital bleeding. Physical examination revealed an ulcerated cervical lesion; however, HPV DNA screening was unavailable. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 3.0 cm mass with dual squamous and glandular differentiation, staged as pT1b1 Nx Mx according to the AJCC eighth edition. Due to a lack of equipment, radical lymphadenectomy and adjuvant radiotherapy were not performed. A 5-year surveillance plan was proposed for postoperative follow-up. Clinical discussion: This case highlights the gap between basic care and enhanced international standards for cervical malignancies in women. The Nx status reflects incomplete nodal staging in a resource-limited setting. Lack of equipment limited the ability to provide appropriate, screening-based surgical management, making prospective postoperative surveillance necessary. Conclusion: ASCC necessitates early detection and standardized multimodal care, objectives that are frequently precluded by infrastructure constraints in Sub-Saharan Africa. Improving outcomes for such aggressive histologies requires a concerted global effort to expand access to HPV vaccination, DNA-based screening, and equitable radiotherapy infrastructure. This may improve the likelihood of curative treatment in resource-constrained environments.