Kazumi Nakazawa

Background: The occurrence of clear-cell adenocarcinoma (CCAC) in the uterine cervix is very rare. We report a case of CCAC diagnosed by preoperatively cervical smears.<BR>Case: The patient was a 74-year-old woman whose endometrial smears were diagnosed as positive at another hospital. When she was referred to our hospital, she had some atypical genital bleeding. Her cervical smears showed CCAC. Simple total hysterectomy and adnexectomy were conducted based on her general condition. Cervical smears demonstrated varied tumor cells with remarkable cytoplasm, large nuclei, and bare nuclei-often large bare nuclei having lost cytoplasm and hobnail cells. Histologically, tumor cells showed a papillary structure with hobnail cells, solid nests, and composite areas.<BR>Conclusion: CCAC of the uterine cervix difficult to diagnose in the absence of hobnail cells in smears. It becomes ever more difficult when other tumor cells appear independently in smears. Since CCAC prognosis is generally dismal, it is important that preoperative differential diagnosis be done carefully to derermine the most appropriate surgical procedure.