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February 28, 2026

The Deceptive Signal: p16 Positivity Suggestive of Human Papilloma Virus Infection Masking a Second Primary Malignancy – A Case Report and Review on Literature

Key Points

To explore the rarity of synchronous primary malignancies of the female genital tract and the role of p16 positivity in diagnosis.
Presenting case of a 75-year-old woman with vaginal bleeding.
Imaging and histopathological evaluations were conducted.
Laparotomy and radical hysterectomy performed for staging.
Adjuvant radiotherapy administered postoperatively.
Two distinct malignancies identified: endometrioid adenocarcinoma and cervical squamous cell carcinoma.
No metastases detected in nodes or peritoneal regions.
Emphasized the need for careful interpretation of p16 positivity.

Abstract

Introduction: Synchronous primary malignancies of the female genital tract are rare, comprising a small subset of gynecologic cancers. The concurrent presence of endometrioid endometrial adenocarcinoma and Squamous Cell Carcinoma (SCC) of the cervix is exceptionally rare. It accounts for less than 1% of reported cases. Case Presentation: A 75-year-old postmenopausal woman presented with intermittent vaginal bleeding. Imaging studies revealed a bulky uterus with an endometrial lesion suspicious for malignancy. An initial cervical biopsy identified high-grade papillary SCC of the ectocervix with diffuse p16 positivity. However, the MRI revealed a large endometrial mass that invaded more than 50% of the myometrium. The patient underwent a staging laparotomy with a radical hysterectomy. Histopathological evaluation confirmed two distinct malignancies: a moderately differentiated endometrioid endometrial adenocarcinoma (FIGO Stage IB) with squamous morules and a small, completely excised cervical SCC. No nodal or peritoneal metastases were identified. Postoperatively, the patient received adjuvant external beam radiotherapy and vaginal brachytherapy. Conclusion: This case underscores the importance of a multidisciplinary approach, including immunohistochemistry and imaging, in diagnosing synchronous gynecological malignancies. Recognizing the coexistence of distinct tumors is essential for accurate staging and tailored treatment planning to improve patient outcomes.

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Cite This Study

Kumar et al. (Mon,) studied this question.

synapsesocial.com/papers/69a287f20a974eb0d3c03e17 https://doi.org/https://doi.org/10.2174/0118715265413651251029062614

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