“ MRI demonstrated the typical findings of superficial spread in our patient, with a hyperintense lesion on DWI in the endocervical region and corresponding low signal intensity on the ADC map .”
BUFFALO, NY — September 2, 2026 — A new case report was published in Volume 13 of Oncoscience on July 29, 2026, titled “ MRI in deciphering the superficial spread of cervical squamous cell carcinoma into the uterine corpus: A case report and literature review .”
The report was led by first author Naina Kumar from the Department of Obstetrics and Gynecology at the All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India . The corresponding author, Aparna Jarathi, is from the same department.
Cervical squamous cell carcinoma (SCC) typically involves the uterine corpus through deep myometrial penetration or lymphatic dissemination, but superficial extension from the cervix into the uterine corpus is uncommon and remains poorly understood. This unusual pattern can create diagnostic challenges, particularly because involvement of the myometrium and adnexa is not specifically incorporated into the FIGO 2018 cervical cancer staging system. In this report, the researchers describe how magnetic resonance imaging (MRI), histopathology, and immunohistochemistry helped characterize an unusual case of cervical SCC extending superficially into the uterus and left fallopian tube.
The case involved a 54-year-old postmenopausal woman who presented with postmenopausal bleeding and lower abdominal pain lasting three months. A Pap smear and subsequent cervical biopsy revealed squamous cell carcinoma. Clinical assessment initially classified the disease as FIGO 2018 stage IA. MRI, however, revealed an irregular endometrial cavity and a 2.3 × 0.8 cm T2 hyperintense lesion involving the posterior lip of the cervix, with mural spread along the uterine myometrium. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping also demonstrated restricted diffusion in the lesion. Based on these imaging findings, the provisional diagnosis was revised to superficially spreading cervical SCC involving the uterine endomyometrium, and the tumor was upstaged to FIGO stage IB3.
The patient subsequently underwent radical hysterectomy. Histopathological examination confirmed pT1b3 cervical SCC with superficial spread into the endometrium and myometrium, with myometrial invasion of less than 50%. A 0.5 cm nodule at the fimbrial end of the left fallopian tube also contained SCC. Immunohistochemistry showed p16 and p63 positivity and negative estrogen receptor (ER) and progesterone receptor (PR) staining in the tumor. Together with the continuity of the lesions, these findings supported secondary endometrial involvement originating from the cervical cancer rather than a separate primary endometrial malignancy.
MRI was particularly important because superficial spreading cervical SCC may not present as an obvious cervical mass. The authors explain that MRI provides detailed soft-tissue visualization, while DWI and ADC mapping can improve distinction between tumor and surrounding tissue. In this patient, the imaging pattern suggested extension into the uterine body before surgery, and subsequent histopathology confirmed the spread.
The literature review identified several previously reported MRI patterns associated with superficially spreading cervical SCC. These included focal or irregular endometrial thickening, fluid accumulation within the uterine cavity, loss of the normal junctional zone, intramural nodules, and restricted diffusion. Because an obvious cervical growth was not present in all reported cases, the authors emphasize the potential value of recognizing these less typical imaging features when evaluating suspected cervical malignancy.
Pathological examination provides another essential layer of evidence. The authors discuss two proposed mechanisms for this unusual pattern: horizontal spread, in which cervical neoplastic cells extend along and replace the endometrial epithelium, and a vertical or “field” mechanism in which malignant lesions could arise independently under a shared carcinogenic influence. In most reported cases, however, the evidence favors direct extension of cervical cancer. Histological continuity between cervical, endometrial, and fallopian tube lesions can help support this interpretation.
“ In this case, the presence of contiguous spread from the cervix to the endometrium, as seen on MRI, and the histopathological findings supported a diagnosis of secondary endometrial involvement by cervical SCC. ”
Following surgery, a multidisciplinary oncology team decided against additional chemoradiation. At 18 months after surgery, the patient remained clinically well with no evidence of disease recurrence. The authors note, however, that treatment decisions for this rare pattern of cervical cancer require careful individual assessment and that prospective studies are needed to better establish optimal management.
Overall, this case highlights how MRI, particularly when combined with DWI and ADC mapping, can help identify unusual superficial extension of cervical SCC that may be difficult to appreciate through clinical examination alone. Histopathology and immunohistochemistry remain important for supporting tumor origin and distinguishing secondary endometrial involvement from a primary endometrial malignancy. Because the findings are based on a single patient and a review of a limited number of previously reported cases, they should not be interpreted as establishing a universal diagnostic or treatment approach. Instead, the report underscores the importance of integrating imaging, pathology, and multidisciplinary clinical assessment when cervical cancer displays an atypical pattern of spread.
DOI: https://doi.org/10.18632/oncoscience.668
Correspondence to: Aparna Jarathi – aparna.obg@aiimsbibinagar.edu.in
Keywords: cancer, postmenopausal bleeding, MRI, p16, p63, ER, PR
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MRI in deciphering the superficial spread of cervical squamous cell carcinoma into the uterine corpus: A case report and literature review
29-Jul-2026
Authors have no conflicts of interest to declare.