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729 ‘Silent’ HPV-associated cervical cancer: isolated cerebellar metastasis as the first symptom of cervical adenocarcinoma. A case report and literature review
  1. Marco Cerbone,
  2. Maria Bardi,
  3. Anna Aquilino,
  4. Marta Mele,
  5. Maria Bentivoglio,
  6. Miriam Dellino,
  7. Antonella Vimercati,
  8. Gennaro Cormio,
  9. Ettore Cicinelli and
  10. Marco Marinaccio
  1. University of Bari, Bari, Italy


Introduction/Background Primary central nervous system metastases (CNS) from gynaecological cancer are extremely rare and considered ‘neurophobic’, usually developing as part of a widespread disseminated disease. In cervical cancer brain metastases are rare (2%). In this report, we present a case of endocervical carcinoma onset with an isolated cerebellar metastasis in a woman with no remarkable history and no preliminary evidence of cervical disease.

Methodology We reported data from hospital registry and the available literature with PRISMA methodology.

Results A 48-year-old woman arrived at our Emergency Room with confusion. The CT scan showed an obstructive hydrocephalus due to a mass in the IV ventricle, which was excised in urgent neurosurgical ward without complications. The histological study revealed a cerebellar adenocarcinoma metastasis of suspect endocervical origin. A gynecologic specular evaluation showed a portio with friable tissue in its upper labium involving all the fornices. At the vagino-rectal examination, the cervix had improved volume and a harder-than-normal texture with infiltration of both parametria. An hysteroscopic biopsy was performed, with final histology of adenocarcinoma, HPV associated, of the uterine cervix. The immunohistocheminstry was CK7+, TTF-1+, p16+ and P40-, Synaptophysin-, ChromograninA- and PAX8-. An abdominal RMI showed a heterologous expansive cervical mass of 6 cmx2.5cmx5cm. The patient was not eligible for chemotherapy or radiotherapy because of poor performance status and counselled for palliative care.

Conclusion We presented the case of a silent onset of cervical neoplasia in a woman with neurological symptoms. Brain metastases usually develop lately in the clinical history of the patients. However, in some uncommon cases, isolated brain metastasis can be the initial site of presentation of this neoplasia, with headache and confusion as the most common symptoms. Brain metastases are the most common brain tumours in adults, but the molecular and biological mechanisms that facilitate the formation of CNS metastases are still poorly understood.

Disclosures The author declare no conflicts of interests.

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