A 54-year old, single, nulligravid, without history of sexual contact, was admitted due to postmenopausal bleeding. Transrectal ultrasound revealed myoma uteri and thickened endometrium. She was thus scheduled to undergo endometrial curettage. However, prior to the performance of the endometrial sampling procedure, there was profuse vaginal bleeding with note of a possible prolapsed submucous myoma. She thus underwent emergency exploratory laparotomy with total hysterectomy and bilateral salpingooophorectomy.

Intraoperatively, necrotic masses were noted within the endocervical canal. Frozen section of the uterus and these masses revealed malignancy. Intraoperative referral to a gynecologic oncologist was done and bilateral pelvic lymphadenectomy and surgical staging were performed. Final histopathologic report revealed Cervical Adenosquamous Carcinoma. She subsequently underwent external beam radiotherapy and vaginal brachytherapy.

With the knowledge that almost all cases of cervical cancer is due to the Human Papilloma Virus (HPV), that this virus is almost exclusively transmitted by sexual contact, and the fact that she never engaged in sexual practices, there was doubt as to the source of the cancer. To help resolve this issue, an HPV DNA Polymerase Chain Reaction assay was performed on paraffin block samples and these all turned out negative for HPV. She may possess one of the rarest forms of cervical cancer - one that is not associated with the Human Papilloma Virus.

Human ; Female ; Middle Aged ; Uterine Cervical Neoplasms ; Papillomaviridae ; Brachytherapy ; Carcinoma, Adenosquamous ; Laparotomy ; Myoma ; Leiomyoma ; Endometrium ; Uterine Hemorrhage ; Hysterectomy