Cervical Intraepithelial Neoplasia in Pregnancy

Nonette  C. Urayani,

Cervical Intraepithelial Neoplasia in Pregnancy

Abstract:

Introduction: It is a challenge for Obstetricians to manage patients with abnormal cervical screening tests and cervical neoplasia while they are pregnant. Case: This is a case of a 28-year-old primigravid diagnosed at 6 weeks AOG of pregnancy with Atypical Squamous Cells, cannot exclude High Grade Squamous Intraepithelial Lesion (ASC-H) on Pap smear.A colposcopically-guided cervical punch biopsyat 8 weeks AOG revealed Carcinoma in Situ of the cervix with endocervical gland involvement. At 29- and 32-weeks’ age of gestation, 2D/3D Transrectalultrasound with Doppler studies revealed an endophytic cervical mass with abundant vascularization. Ultimately, the patient delivered a live, full term healthy baby girl. Eight weeks after delivery, the patient had a Pap smearwhich revealed persistence of atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion. This was followed a week later by ultrasound-guided fine needle aspiration biopsy, and a colposcopically-guided biopsy which revealed a regression of the endophytic endocervical mass, negative for malignancy, and regression of CIN III to CIN I, acute on chronic cervicitis, with focal koilocytic changes, respectively Discussion/Conclusion: Management of Cervical Carcinoma in Situ in pregnant women is a diagnostic entails a multidisciplinary approach involving the obstetrician, the perinatologist and the gynecologic oncologist.

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