OBJECTIVES: To summarize ultrasonographic features of rare primary and common cervical cancer and the association of these cancers with HPV infection so as to diagnose rare primary cervical cancer. METHODS: Sixty-five cases with cervical cancer suspected by ultrasonography and three cases with clinical symptoms treated at our department underwent cervical biopsy. Sixty-four diagnosed cases were retrospectively analyzed and divided into common-type (CTCC) and rare-type (RTCC) cervical cancers. RESULTS: Sixty-one cases were diagnosed, four misdiagnosed, three missed the diagnosis by ultrasonography, the sensitivity of which was 95.31% (61/64). The common-type cervical cancer had 43 cases of squamous cell carcinoma. The rare-type cervical cancer had 15 cases of adenocarcinoma, four of small-cell carcinoma, and two of adenosquamous carcinoma. The demographic characteristics of the two groups were not significantly different (P > 0.2). The tumor size in RTCC were smaller than those in CTCC (P < 0.05). Hypoechoic lesions in CTCC and isoechoic lesions in RTCC composed 74.42% (32/43) and 61.90% (13/21), respectively (P < 0.001). Exophytic in CTCC and endophytic in RTCC composed 67.44% (29/43) and 66.67% (14/21), respectively (P = 0.01). HPV infection composed 83.72% (36/43) in CTCC and 47.62% (10/21) in RTCC, respectively (P = 0.003). Color Doppler blood signals were found in all cases, as compared with normal cervical tissue. The consistency between ultrasonography and pathology staging diagnosis of RTCC was good (Weighted kappa (95%CI) = 0.87). CONCLUSION: Ultrasonography can distinguish RTCC from CTCC. There is a very good consistency between ultrasonography and pathology staging diagnosis of RTCC.