Carcinoma of the cervix complicating irreducible complete uterine prolapse: A case report and review of literature

Abstract

Background: Cervical cancer continues to pose a major public health burden in India, ranking as the second most common malignancy among women. While both cervical carcinoma and pelvic organ prolapse (POP) are prevalent conditions, their coexistence particularly carcinoma of the cervix with complete uterovaginal prolapse is exceedingly rare. The altered pelvic anatomy and advanced presentation create unique diagnostic and therapeutic challenges without established management guidelines. Case Presentation: We report the case of a 43-year-old HIV-positive woman who presented with a 4-month history of a descending vaginal mass, which became irreducible over the preceding two months. Pelvic examination revealed grade 4 uterine prolapse with a large friable cervical growth. MRI demonstrated a 6.4 × 6.4 cm cervical mass protruding through the introitus without pelvic lymphadenopathy. Biopsy confirmed moderately differentiated squamous cell carcinoma. The patient underwent radical vaginal hysterectomy with bilateral extraperitoneal pelvic lymphadenectomy, followed by adjuvant chemoradiation. The postoperative course was uneventful. Discussion: A review of 14 published cases revealed a mean age of 74.4 years, with squamous cell carcinoma being the predominant histology and Stage II the most frequent stage at diagnosis. Management strategies have varied widely, although radical vaginal hysterectomy with or without adjuvant chemoradiation has been most commonly performed, yielding generally favorable outcomes in operable patients. Anatomical distortion due to prolapse complicates both surgical dissection and radiotherapy planning. Conclusion: Cervical carcinoma with complete uterovaginal prolapse remains a rare but clinically important condition requiring individualized, multidisciplinary management. When feasible, multimodal treatment including surgery, radiotherapy, and chemotherapy offers the best outcomes. Further data collection through multicentre registries is needed to develop evidence-based guidelines for this uncommon presentation.