Uterine cervix metastasis from a sigmoid adenocarcinoma: a rare presentation of an uncommon tumor
© Berhili et al.; licensee BioMed Central Ltd. 2014
Received: 11 March 2014
Accepted: 26 August 2014
Published: 1 December 2014
Metastatic carcinoma to the uterine cervix from colorectal cancer, through haematogenous or lymphatic spread, is extremely rare. We report the case of a 59 year old woman in whom cervical metastasis was diagnosed after 13 months of follow-up for a sigmoid adenocarcinoma, confirmed by immunohistochemical study, with a review of the literature. This case illustrates that abnormal gynecologic symptoms can reveal a disease progression on patients who suffer colorectal cancer.
Metastases to the female genital tract from extragenital malignancies are very uncommon, and the most common extra-genital primary sites are breast and gastrointestinal system [1, 2]. Common metastatic sites of colorectal cancer include the liver, lung, lymph nodes and peritoneum, but the rarest would be the uterine cervix [3, 4]. We report in this article a case of metastatic adenocarcinoma from a sigmoid primary to the uterine cervix, with a review of literature on uterine cervix metastasis from colorectal cancer.
daily fractions of decompression radiotherapy were scheduled (3 Gy per fraction), but the patient received only six fractions, she died before completing his treatment, two days after presenting a coma secondary to brain metastases, asymptomatic at the time of admission. Cervical tumor has therefore not been treated.
Involvement of the uterine cervix through direct extension of extra-genital neoplasia is frequent. However, metastatic carcinoma to the cervix through haematogenous or lymphatic spread is extremely rare [1, 3]. Contrary to ovaries which provide a suitable environment for metastatic cells, the uterine cervix is rarely the site of metastases because of its fibrous tissue content, small size, relatively limited blood flow, and the lymphatic vessels of the pelvis all draining away from the cervix . Thus, the uterus is rarely involved accounting for less than 10% of all cases of metastases to the female genital tract from extra-genital cancers (3.4% for the uterine cervix alone) . Only few cases have been reported during the past several decades; the youngest patient was 17 years old . These patients carry a dismal prognosis .
Nakagami et al. , reviewed 27 cervical metastases from colorectal carcinomas, including a majority of colonic primaries. The average interval between primary carcinoma and uterine cervix metastasis appearance was 17 months (0–60 months), it was 13 months for our patient. The average survival after cervical metastasis diagnosis in Nakagami’s review was 11 months.
In our case, leucorrhea appeared 3 months before the diagnosis of metastasis. Gynecological symptoms following medical history of colorectal cancer should be taken into consideration in order to refer rapidly patients for adequate treatment.
Adenocarcinoma histology type represents 0.42 to 11.7% of all cervix carcinomas , however the incidence of metastatic adenocarcinoma was reported to be 21.6 to 56.9% of cervical adenocarcinoma [11, 12].
In pathology study practice, CK7 and CK20 immunoexpresssions are commonly used in combination to evaluate immunoreactivity pattern in tumor cells, to confirm the origin of metastatic disease with unknown primary sites . CK7 immunoreactivity is observed in tumors of lung, breast, upper gastrointestinal and pancreatobiliary tract, endometrium, vagina, and ovary, while tumors of colonic origin are generally non-reactive to this immunomarker. CK20 immunoexpression is detected in tumors of gastrointestinal tract and urothelium . CDX2 immunoexpression has proven to be useful in establishing gastrointestinal origin in metastatic tumors, and has become a useful addition to the standard immunohistochemical stains list for carcinomas of unknown primary sites .
In our case, the spread of the tumor to the uterine cervix might have been caused by lymphatic and/or hematogenous pathways. Since lesion by direct extension from the primary sigmoid tumor was excluded (R0 resection was performed), and lymphatic channels of the cervix that routinely drain centrifugally, were blocked by surgery and retrograde flow might occur [5, 16, 10].
In conclusion, metastases to the female genital tract from extragenital cancers are uncommon and have a poor prognosis [9, 10]. Multidisciplinary approach including immunohistochemical study is required to diagnose these rare cases, and any gynecological symptoms following medical history of colorectal carcinoma should bear in mind metastases in order to appropriately assist these patients.
Written informed consent was obtained from the next of kin of the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We thank Mehdi El Amrani Omari and Adnane Mansour for their contributions in editing this English redaction.
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