# Cervical Adenocarcinoma In Situ in Young Nulliparous Patient with Persistent ASC-US and Multiple-Type HPV Infections Without HPV 16 and 18 Types—Case Report

## TL;DR

A young woman with persistent low-grade cervical cell changes and multiple HPV infections, but not HPV 16 or 18, was diagnosed with a rare cervical cancer precursor.

## Contribution

Highlights diagnostic challenges of glandular lesions in young patients with persistent ASC-US and non-16/18 HPV infections.

## Key findings

- A nulliparous patient with persistent ASC-US and multiple HPV types (excluding 16/18) was diagnosed with cervical adenocarcinoma in situ.
- Diagnosis required multiple biopsies and conization due to limited sensitivity of screening for glandular lesions.
- Case underscores the need for caution in managing young patients with persistent low-grade cytology and high-risk HPV.

## Abstract

The most severe premalignant lesion of glandular epithelium of the cervix is adenocarcinoma in situ (AIS). In most cases it is associated with persistent human papillomavirus (HPV) infection and most often occurs in women in the fourth decade of life. In most high-income countries, primary screening has shifted to HPV testing, while cytology is used for patient triage. Even with current robust screening protocols, their sensitivity for glandular lesions remains limited. Diagnosis of AIS obtained by biopsy, brushing or curettage is confirmed by excisional methods and pathohistological verification. Therapy depends on the patient’s lifestyle and reproductive age. In our case, we present a nulliparous patient with persistent ASC-US, multiple-type HPV infection without HPV 16 and 18 types, and AIS which was diagnosed after conization, follow-up and two biopsies with curettage of cervical canal. Our case report highlights limitations in detection of glandular lesions and need for caution in patients with persistent and seemingly low-grade cytological abnormalities, notably in young patients with high-risk HPV types.