The patient, a 28-year-old woman, has been sexually active with multiple partners since she was 14 years
old. She is now married and wants to have children. She has intermittent |
breakouts of vulvar ulcers/sores but no other complaints. Her pelvic examination during a
routine visit with her gynecologist was normal. She had a lump in her left breast.
infections (STIs), Herpes simplex test, Positive for herpes simplex virus-2 (HSV-2) (normal: negative)
No change in serology 4 weeks later
Cytomegalovirus, No antibodies detected
Chlamydia, No antibodies detected
Gonorrhea, Culture negative
Syphilis serology, No antibodies detected
Pap smear, Adequacy of specimen Adequate Category Epithelial abnormality Epithelial cell abnormalities
Squamous, atypical cells
Human papillomavirus (HPV)testing, Positive for HPV 16
Breast sonogram, Benign fibroadenoma
‘ The patient was informed of her test resuits. Her herpes titers indicated that the disease was rather chronic,
not acute. No treatment was recommended. Because of her age,
mammograms were contraindicated. A breast ultrasound indicated the lesion was not
cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV
results and suspicious Pap smear, further evaluation was recommended.
Colposcopy, Several suspicious areas
Biopsy Squamous cell carcinoma
Cervical cone biopsy, Invasive squamous cell carcinoma
Hysteroscopy, No extension to the endocervical canal or uterus
Pelvic ultrasound, No extension of tumor beyond the cervix
The patient was advised to have a radical hysterectomy. She refused because she wanted to have a family.
She began psychologic counseling for guilt over her past promiscuity, which had increased her risk for
cervical cancer. She became pregnant 1 year later and lost the pregnancy during the second trimester.
One year later, she developed a large pelvic mass, which represented progressive, inoperable cervical
cancer. Despite radiation therapy and chemotherapy, she died at age 31 of cervical cancer.
Critical Thinking Questions