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431 Tumor resection of an isolated pulmonary metastasis after a 3-year remission in a patient with locally advanced cervical cancer. A case report
  1. Jimmy A Billod
  1. Baguio General Hospital and Medical Center, Baguio City, Philippines

Abstract

Introduction/Background Hematogenous spread of cervical cancer is uncommon and an isolated pulmonary metastasis (IPM) is 3.1–9.9%. This article presents an isolated pulmonary metastasis of cervical cancer detected after 3 years of remission.

Methodology Case Review.

Results A 32-year-old, diagnosed with Cervical Cancer, SCCA Stage IIIB 48 months prior to the lung mass resection. She had concurrent chemoradiation followed by brachytherapy. Surveillance examinations and cytology revealed negative until 6 months prior to the lung mass resection, she had chronic cough, pulmonary tuberculosis workups were negative. Chest CT scans showed an irregularly shaped, complex mass measuring 5.6 x 5.4 x 4.8 cm centered in the right middle lobe. She underwent VATS exploration, wedge biopsy of the lung mass with rush frozen section which revealed invasive squamous cell carcinoma; and conversion to posterolateral thoracotomy with intraoperative fluoroscopy revealing 5 x 6 cm RML mass. Right middle lobectomy was done. The final biopsy of the RML mass was poorly differentiated squamous cell carcinoma, 0.6 cm from the nearest resection margin. She received 6 cycles of carboplatin-paclitaxel. Two consecutive chest and abdominopelvic CT scans 6 months apart showed no evidence of tumor recurrence or residua. Presently, she has ECOG 0, no subjective complaints, no progression of disease 24 months after lung metastasis resection, and alive for 72 months since diagnosis of cervical cancer.

Conclusion Pulmonary metastasis is detected in most patients with a mean time of 24 months after cervical cancer diagnosis. Aside from the stage, non-SCC histology, poor differentiation, nodal involvement, tumor size > 4 cm, and presence of LVSI are usual risk factors for the development of pulmonary metastases. Tumor resection seems to provide a longer survival for isolated lesions and should be offered to patients with IPM. Identifying patients with high risk for lung metastases and taking early intervention are important to gynecological oncologists.

Disclosures None.

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