Doctors at KIMS Saveera Hospital, Anantapur, successfully treated a rare case of cervical cancer in a 42-year-old woman with a lifelong history of primary amenorrhoea (absence of menstruation) caused by a congenital reproductive system anomaly.
Unusual Presentation Without Typical Symptoms
Dr. Geetha Rani Vellidareddy, Senior Gynaecologist, explained that the patient, a resident of Ballari district in Karnataka, visited the hospital with complaints of white vaginal discharge for three months. However, she did not report common warning signs such as foul smell, itching, pelvic pain, or abnormal bleeding.
Because her symptoms appeared mild and non-specific, doctors proceeded with detailed evaluation.
Medical History Reveals Lifelong Primary Amenorrhoea
Imaging studies revealed a suspicious mass arising from the cervix, while the uterus and ovaries appeared normal. Meanwhile, a detailed medical history uncovered that the woman had never attained menarche.
Previous hormonal assessments had shown normal Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels. Furthermore, she had well-developed secondary sexual characteristics. Despite this, she had never experienced menstrual pain or urinary and bowel complaints, which added complexity to the case.
Diagnostic Challenge Due to Obstructed Vagina
During further evaluation at KIMS Saveera, doctors discovered that the lower end of the vagina was completely closed. As a result, they could not perform a routine cervical examination or biopsy.
Nevertheless, through vaginal and rectal examination, the medical team detected a hard mass measuring approximately 6 × 6 cm. This finding strongly suggested malignancy. Given the inability to obtain a biopsy and the high suspicion of cancer, a multidisciplinary oncology team decided to proceed with definitive surgical management.
Definitive Surgical Management
As per the press release, the team performed a radical hysterectomy along with bilateral pelvic lymph node dissection. During surgery, they identified a fungating cervical growth measuring about 5–6 cm. However, they found the ovaries and fallopian tubes to be normal.
On further examination, doctors observed that the uterus lacked a functional endometrial cavity. Additionally, lymph nodes showed no evidence of cancer spread, which provided some reassurance regarding disease extent.
Rare Developmental Anomaly Identified
Doctors concluded that the extremely underdeveloped endometrium had caused the patient’s lifelong absence of menstruation. Dr. Geetha Rani clarified that this condition was not the commonly recognised Mayer-Rokitansky-Kuster-Hauser syndrome, but rather an exceptionally rare developmental anomaly of the female reproductive system.
She noted that the coexistence of primary amenorrhoea, an obstructed vagina, an underdeveloped endometrium, and cervical cancer is extraordinarily rare. Moreover, making a clinical decision without the possibility of biopsy posed a significant challenge for the team.
Importance of Multidisciplinary Care
Dr. Geetha Rani emphasised that this case underscores the need for heightened vigilance for gynaecological cancers, even in women with congenital reproductive tract anomalies. She also highlighted the importance of seeking care at a multidisciplinary hospital when managing complex and rare conditions.
Overall, the successful outcome reflects timely clinical suspicion, coordinated teamwork, and advanced surgical expertise in handling an exceptionally rare and challenging presentation.