Cervical Squamous-Cell Carcinoma in a Case of Severe Beta Thalassemia/ Hemoglobin E Disease

Abstract

Hematologic malignancies and liver cancers are slightly more common among thalassemia patients than the general population. Here we report a case of cervical cancer in a patient with beta thalassemia/ hemoglobin E disease. A 66-year-old Thai woman presented with spotted vaginal bleeding for two days. Her underlying condition was severe beta thalassemia/ hemoglobin E disease and she needed regular blood transfusions every 3-4 months. Physical examination revealed marked pallor, typical thalassemic facies, and hepatomegaly. Pelvic examination showed an ulcerative mass of 2-3 cm at the cervix, involving the entire fornix and right pelvic wall, with both sides showing inguinal lymphadenopathy. Blood tests showed hematocrit 17.5%, ferritin 3876.1 ng/ml, and negativity for HBV, HCV and HIV. The average hematocrit was 19.2+2.3% before transfusion. Microscopic pathology of the cervical mass found non-keratinizing squamouscell carcinoma. She was clinically diagnosed with carcinoma of the cervix stage IIIB and underlying severe beta thalassemia/ Hb E disease, secondary hemosiderosis and mild transaminitis. After treatment by blood transfusion and chelating therapy, she was referred to the cancer center. Although an association between cervical cancer and severe thalassemia was not clearly established, the emergence of cancers in severe thalassemia cases should be kept under close surveillance because these patients survive longer with regular transfusion and chelation therapy