Glyoxalase 1: A Promising Biomarker And Target For Cervical Cancer Treatment

초록

Introduction/Background Adenocarcinoma reach 10-25% of all cervical cancers and this number is increasing through the past decades. Intestinal-type mucinous endocervical adenocarcinoma is a rare type of mucinous carcinoma usually unrelated to Human Papillomavirus (HPV) infection. It shows more aggressive clinical behavior and worse prognosis compare to usual type of adenocarcinoma. Thus, there is limited study to investigate relation between Programmed cell death-1 (PD-1) and its ligand (PD-L1) as treatment outcomes and prognostic significance. Several studies show that mucinous adenocarcinoma cervix is chemotherapy and radiation resistant therefore surgery has become alternative to achieve optimal outcome. Here we present a case study regarding management of intestinal type of mucinous endocervical cancer stage IIB. Methodology A 47 yo lady presented with post coital bleeding. Histopathology confirmed intestinal-type mucinous endocervical adenocarcinoma with HPV associated and Programmed cell-death ligand 1 (PD-L1) expression Combined Positive Score (CPS) ≥1. MRI shows stage IIB with bulky mass (3.4 x 3.3 x 6 cm). The patient subsequently underwent laparotomy radical hysterectomy with lymph node dissection. Histopathology revealed diagnostic of intestinal-type mucinous endocervical adenocarcinoma, with positive tumor at vaginal margin. Thus, patient received concurrent chemoradiation (CCRT) with three cycle of Pembrolizumab as immunotherapy. Results Patient has achieved local remission after completed her therapy and currently is waiting for PET-CT evaluation. Conclusion Intestinal-type mucinous endocervical adenocarcinoma may need aggressive diagnosis and treatment approach. Surgery may be considered in locally advanced mucinous endocervical adenocarcinoma considering poor response of radiotherapy and chemotherapy.