Cse Report Kurume Medicl Journl, 45,127-131,1998 A Metstsis to Nsl Tip from Cervicl Crcom A Cse Report AKIO KATAOKA, TAKASHI NISHIDA, YOSHITO TOM IOKA, NOBUYUKI HIRAI, MORIO OHBUCHI AND MICHIAKI YAKUSHIJI Deprtment Obstetrics Gynecology, Kurume University School Medice, Kurume 830-00111, Jpn Summry: Metstses to from gynecologicl mlignncies re extremely rre. We present cse metsttic to from crcom utere cervix. We dmistered high-dose focl irrdition to site. The literture on metstses to nose, mxillry suses, pr suses from gynecologic mlignncies is reviewed. Key words utere cervicl cncer, metstsis,, MRI, irrdition INTRODUCTION Crcom utere cervix is fourth most common mlignnt women. In United Sttes, it ccounts for nerly 6,000 deths nnully [1]. The disese spreds to surroundg tissues by direct filtrtion dissemtes by lymphtic hemtogenous pthwys. The common sites extrnodl metstses re lung, liver, bones [2]. The loction metstses s n importnt prognostic fctor determg rpeutic response ptient survivl cervicl cncer [2]. Cutneous metstses from cervicl crcom re extremely uncommon. Furrmore, re hve been no reports metstses to from cervicl cncer. We present cse metsttic to from crcom utere cervix. CASE REPORT A 68-yer-old, grvid 4, pr 4 Jpnese womn presented to Kurume University Hospitl Jnury 1996 2-month history postmenopusl vgl bleedg. Vgl exmtion reveled n ulcertive lesion volvg cervix, no dnexl msses, norml-sized uterus. On exmtion under nessi, cervicl volved entire circumference cervix fornices, re ws vgl bilterl prmetril extension but no extension to pelvic cvity. Cystoscopy ws norml. Cervicl biopsy showed well-differentited squmous cell crcom. Chest rdiogrphs, trvenous urogrphy, computed tomogrphy bdomen pelvis were norml. The serum level SCC (sscc) ws elevted to 32.6 ng/ml (norml rnge <1.5 ng/ml). The ptient ws Stge I Ib, ccordg to FIGO (Interntionl Federtion Gynecologists Obstetricins) clssifiction. A rdicl hysterectomy ws performed on Februry 2, 1996. The pthologic dignosis ws modertely-differentited squmous cell crcom 1). Pthologicl exmtion surgicl specimen showed tht cervicl extended to lower myometrium, metstses to pelvic nodes. The ptient received course postopertive trvgl pelvic rdiorpy (38 Gy 50 Gy). After tretment ptient ws observed s n outptient until June 1996, when sscc ws found to be elevted to 17.6 ng/ml. returned to our hospitl ws dmitted for re-elevtion elevted sscc which ws n 30.8 ng/ml. However, no recurrent ws detected chest, bdomen or pelvis by computed tomogrphy, or bones by G-sctigrm. Received for publiction October 21, 1997 Address for correspondence: Akio Ktok, M.D., Deprtment Obstetrics Gynecology, Kurume University School Medice, 67 Ashi-mchi, Kurume 830-0011, Jpn. Tel: 81-942-35-3311 ext 3567 Fx: 81-942-35-0238
KATAOKA 128 Fig. 1. Histopthologic ppernce ET AL. hysterectomy specimen (H&E, received three decrese three sme tion very 4). 1997. se Mrch, The Medicl Journl biopsy A hed out compled ws fistule. ws tretments, 1997. Vol. 45, No. 1, 1998 neck lesion metsttic foci mount vgi- vesicovgl underwent Gy) decresed died res- cm (75 ptient cell mgnetic lrge irrdited 2.5 ~3.0 urostomy, The squmous dignosed percutnous At obstruc- 2). or ws 1996. from ny showed differentited ptient. Kurume received December, (MRI) rectovgl colostomy view, However, ng/ml cvity 3). Mg/M2, ng/ml. compled rpidly, dischrge, Fig. 2. Frontl pelvic imgg nl 106.5 she onnce 10.6 80 chemorpy. modertely crcom nedplt to swellg showed sscc to time, grew t courses cresed plpted mgnifiction ~100). courses more sscc origl size. her divertg Jnury, Despite disese
NASAL Fig. 3. Histopthologic Fig. 4. Cystic METASTASIS ppernce Kit rume Medicl FROM CERVICAL, demonstrted Journl (H&E, 129 CANCER origl mgnifiction ~100). contrst-enhnced Vol. 45, No. 1, 1998 MRI.
130 KATAOKA ET AL. TABLE 1. Metstses to nose, mxill, orpr suses from gynecologic mlignncies DISCUSSION Metsttic lesions to re rre, but mong se, metstses from renl neoplsms re by fr more frequent [3,4]. To best our knowledge, deposits sk from primry squmous cell crcom utere cervix hve not been described previously, lthough distnt metstses from squmous cell crcom utere cervix re documented [2]. Only few cses hve been reported metstses to mxill, nose, or pr suses from gynecologic mlignncies (Tble 1 ) [2-6]. Brm et l. [7] hve reported ptient presentg substntil mss due to leukemic filtrtion, which lmost disppered when pproprite chemorpy ws strted. Solitry kidney metstses hve been observed every system body, cludg mulle sk res [8]. Brun-Flco Lukcs [9] hve reported metstsis from renl cell crcom to. Seedg to nose from thorcic or bdoml primry my be due to hemtogenous spred pssg through pulmonry circultion n onwrd from hert. The lkge regionl lymphtics to thorcic duct is nor route to pulmonry vsculr circultion. An lterntive explntion is tht when trthorcic pressure is gretly cresed, blood-borne emboli pss through venous plexi drift upwrds to venous suses skull. The pterygoid plexus, cvernous sus, phryngel plexus communicte vertebrl system, my trnsport cells to nose [10]. The conspicuous position nose my duce ptient to compl lesion re, wheres or signs symptoms illness might be ignored. Hence, lthough rre, mss my be first sign widespred mlignncy. It is terestg tht both cses metstses described literture presented no symptoms ttributble to primry, lthough se developed soon fterwrds. In present cse, ptient compled obstruction s well s worseng loclly recurrent. As to tretment such cses, cse metstsis from esophgel cncer ws treted resection, followed by plstic surgery [11]. However, metstses to from gynecologic mlignncies hve poor prognosis. We performed high dose focl irrdition, reduction size. REFERENCES 1. Americn Cncer Society. 1990 Fcts & Figures, New York, Americn Cncer Society 1990;1:8. 2. Crlson V, Delcelos L, Fletcher GH. Distnt metstsis squmous cell crcom utere cervix. Rdiology 1967; 88:961-966. 3. Friedmnn I, Osborn DA. Metsttic tumours er, nose throt region. J Lryngology Otology 1965; 79:576-591. Kurume Medicl Journl Vol. 45, No. 1, 1998
NASAL METASTASIS FROM CERVICAL CANCER 131 4. Bernste JIM, Montgomery WW. Metsttic s to mxill, nose, pr suses. Lryngoscope 1966; 76:621-650. 5. Slimi R. Metsttic choriocrcom mucos. J Surgicl Oncology 1977; 9:301-305. 6. Cohen J. Metstse ees Uterussheidenkrzoms der Nse. Ztschrf Lryng 1931; 21:452-453. 7. Brm ID, Goldfrb A, Shlev O, Ariel I. Tumor nose s presentg feture leukemi. J Lryngology Otology 1982; 96:83-86. 8. Toli BM, Whitmore WF. Solitry metstsis from renl cell crcom. J Urology 1975;114:836-846. 9. Brun-Flco O, n Lukcs I. Hypernehrommetstsen der Hut ihre Behlungsmoeglichkeiten. Hutrz 1971; 22:452-457. 10. Btson O. The function vertebrl ve ir role spred metstses. Ann Surg 1940; 112:138-149. 11. Gult DT, Subbuswmy SG. Metsttic tumours. Br J Plstic Surg 1985; 38:570-574. Kurume Medicl Journl Vol. 45, No. 1, 1998