HPV-associated moderately differentiated squamous cell carcinoma of the cervix with pathologically confirmed bladder invasion and radiologically presumed adrenal metastasis in a patient with prior lung adenocarcinoma resection: a rare case report and clinical discussion

Background: Cervical squamous cell carcinoma (CSCC) rarely presents with urinary system symptoms as the initial manifestation. When the tumor invades the bladder trigone, it may mimic primary urologic disease. We report a case with pathologically confirmed bladder invasion. Case: A 74-year-old woman with a history of left lung adenocarcinoma resection (pT1bN0M0, stage IA2) presented with anuria, bilateral hydronephrosis, and fever. Initial workup revealed acute kidney injury (creatinine 720.5 μmol/L) and severe urinary tract infection. Emergency bilateral ureteral stenting and transurethral bladder biopsy were performed. Transurethral biopsy showed squamous epithelial hyperplasia with focal atypia; immunohistochemistry (IHC) revealed CD34+, GATA3 focal weak+, CK7+, CK20-, P63+, Ki-67 15%, insufficient for definitive malignancy. Persistent hydronephrosis prompted laparoscopic exploration in July 2023. A biopsy taken from the vesicouterine junction (interface between bladder and uterus) showed invasive squamous cell carcinoma with diffuse p16 positivity (CK7+/CK20-/P63+), providing pathological confirmation of bladder wall invasion by cervical cancer. Gynecologic consultation then identified a 2.5 cm cervical mass with contact bleeding, and cervical biopsy confirmed moderately differentiated CSCC with diffuse p16 block positivity. Staging imaging demonstrated a radiologically presumed isolated 4.2 × 2.5 cm right adrenal metastasis without other distant metastases. Final clinical diagnosis: HPV-associated CSCC, clinical FIGO stage IVB (pathologically confirmed bladder invasion, radiologically presumed adrenal metastasis without histologic confirmation). The patient underwent palliative ileal conduit urinary diversion, which provided short-term renal function improvement; she died 2 months after definitive diagnosis due to widespread disease progression. Conclusion: CSCC presenting with obstructive uropathy is rare and easily misdiagnosed. Gynecologic history taking and pelvic examination are imperative for female patients, and should be performed promptly, especially in the setting of adjacent organ lesions. The combination of imaging evidence of anatomical continuity and CK7+/CK20-/P63+/p16+ IHC profile has auxiliary value for differential diagnosis. Comprehensive staging including adrenal evaluation is essential. Early palliative urinary diversion may provide temporary relief in selected patients.