Abdominal Scar Recurrences of Cervical Cancer: Incidence and Characteristics: A Case-Control Study

Cervical cancer recurrence presenting as abdominal wall mass and accompanying cellulitis

Background

Most recurrences of early stage cervical cancer occur in the pelvis or lymphatic system. Distant metastases occur in a minority of patients. Large abdominal wall recurrence presenting as cellulitis and intra-abdominal mass is unusual and presents diagnostic as well as treatment challenges.

Case

A 46-year-old woman with a history of stage 1B1 poorly differentiated squamous cell carcinoma of the cervix 2 years earlier presented with infraumbilical abdominal wall erythema, tenderness and warmth to the touch. She had a subcutaneous mass in that area with associated abdominopelvic pain. Imaging showed a 9.5 × 11 cm lobulated mass in the anterior lower abdominal wall, encompassing the width of the lower rectus muscles also invading the small bowel and the bladder. Superimposed cellulitis led to the symptoms with which she presented. She was treated with intravenous antibiotics, and biopsy of the mass revealed squamous cell carcinoma consistent with her prior cervical cancer. She was treated with neoadjuvant chemotherapy followed by surgical debulking with negative margins and adjuvant chemotherapy. Three months after completing treatment she recurred in the inguinal lymph nodes and restarted multimodality treatment. She was without evidence of disease for the entire 18 months of follow up following treatment to the lymph nodes.

Conclusion

Cervical cancer recurrence patterns can be unique. Surveillance for recurrence may also include consideration of these unusual patterns of recurrence.

Rare Presentation of Isolated Scar Site Recurrence in a Case of Carcinoma Cervix

Scar site recurrence is a rare phenomenon and is even rarer in squamous cell carcinoma. We present a special case of isolated scar site recurrence in a patient with carcinoma cervix detected on fluorodeoxyglucose positron emission tomography-computed tomography, 2 years after hysterectomy and radiotherapy.

Impact of Abdominal Wall Metastases on Prognosis in Epithelial Ovarian Cancer

Objective

Epithelial ovarian cancer (EOC) patients with the presence of abdominal wall metastasis (AWM) are categorized as stage International Federation of Gynecology and Obstetrics (FIGO) IVB, irrespective of other biologic factors or preceding invasive intervention before final surgery. We evaluated the impact of AWM on patients’ overall survival (OS).

Patients and Methods

In this exploratory study, 634 consecutive patients with advanced EOC treated in our center from 2000 to 2014 were included. Patients were categorized into FIGO IIIC (n = 308), FIGO IVB AWM only (n = 86), and FIGO IV others (metastases other than AWM, n = 240). Clinicopathological parameters and survival data were extracted from our prospectively maintained tumor registry. Survival analyses were calculated using Kaplan-Meier method and Cox regression models.

Results

In 75 (87.2%) of 86 cases, AWM was seen after a preceding intervention, and only in 12.7%, the deposits were spontaneously established. The median OS in patients with stage FIGO IIIC, FIGO IVB AWM only, and FIGO IV others was 37, 58, and 25 months (P < 0.001), respectively. Patients with FIGO IVB AWM only had a significantly better OS than patients with FIGO IV others (P < 0.001). The numeric longer OS of patients with FIGO IVB AWM only compared with patients with FIGO IIIC was not statistically significant (P = 0.151). In multivariate analysis considering all confounding factors including residual disease, OS of patients with FIGO IIIC did not differ from patients with FIGO AWM only (hazard ratio, 0.84; 95% confidence interval, 0.56–12.26; P = 0.398).

Conclusions

Most AWM are acquired after preceding intervention (puncture or laparoscopy). Prognosis of patients with AWM as the only site of distant metastasis is superior compared with other stage FIGO IV patients. Therefore, up-staging of patients only because of AWM to FIGO IVB may be questioned. A revision/clarification of the FIGO classification system should be considered to avoid unnecessary stigmatization of patients and to classify these patients more appropriately according to prognosis.

Surgical Scar Site Recurrence in Patients With Cervical Cancer on 18F-FDG PET-CT: A Case-Control Study

PURPOSE

The purpose of this study was to assess the role of fluorine 18 ((18)F)-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) in evaluating various parameters in patients with surgical scar site recurrence in cervical carcinoma.

METHODS

Data of all patients with cervical cancer (n = 329) who underwent PET-CT at our institute between 2005 and 2013 was reviewed. Of these 329 patients, 132 patients who were surgically treated and underwent restaging/follow-up PET-CT were included in the present study for final analysis. Tumor recurrence at the abdominal surgical scar site was looked for. Abnormal uptakes suggestive of active disease at other sites were also noted. Maximum standardized uptake value was measured for all the lesions. Patients with scar site recurrence were taken as cases (n = 6), whereas the remaining patients served as controls (n = 126). Comparison with conventional imaging modalities was made wherever available. Histopathological examination was always sought for.

RESULTS

The incidence of scar site recurrence after surgery was found to be 4.5% (6/117). A total of 56 of 132 patients had recurrent disease, including 6 patients with scar site recurrence. All of the patients with scar site recurrence also had recurrent disease at other sites (local, nodal, or distant). Conventional imaging modalities were available in 4 of these 6 patients and detected scar site recurrence in 3 of those 4 patients. In patients with scar site recurrence, the mean ± SD time to scar site recurrence was 14.0 ± 10.9 months (median, 10 months; range, 7-36 months). Significant difference was seen between cases and control for International Federation of Genecology and Oncology stage (P = 0.001) and nodal recurrence (P = 0.007). Additionally, age, nodal recurrence, distant recurrence, and scar site recurrence were significantly associated with death.

CONCLUSIONS

Scar site recurrence carries a poor prognosis, and the incidence is much higher than previously known when PET-CT is used as a modality for its detection.

Incisional site metastasis in a patient with cervical carcinoma: a case report and review of the literature

Abdominal wall metastasis either incisional, drain, or port is rather rare in patients treated for cervical carcinoma. We present a case of a patient who underwent an abdominal radical hysterectomy for a moderately differentiated cervical adenocarcinoma stage Ib1 and presented an incisional site metastasis 36 months after her operation. Moreover, we performed a literature search for abdominal wall metastases after radical hysterectomy for cervical cancer, and we present a table of the relative case reports. After our literature search, we clarified that the median time of recurrence was 14 months (range 1.5 month to 45 months). Thirty-three out of 42, 8/42, and 1/42 were squamous, adeno-, and adenosquamous carcinomas, respectively. Wide excision was performed in 30/37 cases of which we have information regarding the treatment option, while 11/37 and 13/37 underwent radiotherapy and chemotherapy, respectively. The possible mechanism of such a metastasis as well as the treatment options is discussed.