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Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 311-312
Bilateral ovarian metastasis of cervical squamous cell carcinoma in a young patient: A rare entity


1 Department of Pathology, JN Medical College, AMU, Aligarh, UP, India
2 Department of Obstetrics and Gynaecology, JN Medical College, AMU, Aligarh, UP, India

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How to cite this article:
Maheshwari V, Jain A, Alam K, Sharma R. Bilateral ovarian metastasis of cervical squamous cell carcinoma in a young patient: A rare entity. Indian J Pathol Microbiol 2008;51:311-2

How to cite this URL:
Maheshwari V, Jain A, Alam K, Sharma R. Bilateral ovarian metastasis of cervical squamous cell carcinoma in a young patient: A rare entity. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Oct 18];51:311-2. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/311/41710


Sir,

Cancer of the uterine cervix is one of the commonest malignancies of the female genital tract, usually presenting in the fourth decade, but its incidence in young females is on the rise. Only occasional reports of its spread to ovaries are available, the incidence varying from 0% [1] to 1.3%. [2] We take the opportunity of reporting bilateral ovarian metastasis of squamous cell carcinoma (SCC) of cervix in a young female.

A 25-year-old woman presented with intermittent postcoital vaginal bleeding. Per speculum examination showed a small cervical growth, which on biopsy revealed large cell keratinizing SCC of cervix. Wertheim's hysterectomy was performed. Grossly, uterus was normal appearing; cervix showed a growth measuring 3.0 2.0 cm, involving the ectocervix and extending little into endocervix. Both the ovaries were normal sized with an intact capsule, but cut sections showed multiple whitish foci measuring 0.2 to 0.3 cm in diameter in both ovaries [Figure 1].

Microscopy of sections from cervix showed sheets of large tumor cells with areas of necrosis, foci of keratinisation and increased mitotic activity. There was no evidence of invasion of endometrium; however, the whitish foci in both ovaries turned out to be foci of tumor cells having the same morphology as that of cervical cancer cells [Figure 2]. Omentum and pelvic lymph nodes were free from metastasis.

All these findings led to a diagnosis of large cell keratinising SCC of cervix metastasizing to both ovaries (stage IV-a according to FIGO staging).

Cervical cancers rarely metastasize to ovaries; and if they do, the incidence is higher in adenocarcinoma (18.6%), followed by adenosquamous carcinoma (6.7%) and the least in SCC (0%), [1] with the mean age of presentation being 57.4 years for SCC and 50.2 years for adenocarcinoma. [3] The primary lesions in such cases show deep myometrial invasion, corpus invasion, lymphatic permeation and even pelvic lymph node metastasis and positive peritoneal washing cytology in few cases, [3] contrary to our case, where the corpus and lymphatics were completely free of tumor invasion, suggesting a direct metastasis to ovaries, most probably via a hematogenous route. Sakuragi et al. have also emphasized that as ovarian metastasis of cervical carcinoma may occur via hematogenous spread, vessel invasion including capillary vessel should be diagnosed separately from lymphatic vessel invasion. [4] The clinical stage beyond II-b is a significant variable for ovarian metastasis of SCC compared to adenocarcinoma, in which tumor size >30 mm is significant. [2]

Therefore, a high index of suspicion, along with various features, including bilaterality of ovarian tumors, histologic features that are unusual for primary ovarian neoplasm and extensive extracervical disease, helps to make a diagnosis of ovarian metastasis.

 
   References Top

1.Aida H, Kodoma S, Aoki Y, Shimizu K, Honma S, Kanazawa K, et al. The study of ovarian metastasis in uterine cancer. Nippon Sanaka Fujinka Gakkai Zasshi 1992;44:315-22.  Back to cited text no. 1    
2.Nakanishi T, Wakai K, Ishikawa H, Nawa A, Suzuki Y, Nakamura S, et al. A comparison of ovarian metastasis between squamous cell carcinoma and adenocarcinoma of uterine cervix. Gynaecol Oncol 2001;82:504-9.  Back to cited text no. 2    
3.Toki N, Tsukamoto N, Kaku T, Toh N, Saito T, Kamura T, et al. Microscopic ovarian metastasis of the uterine cervical cancer. Gynaecol Oncol 1991;41:46-51.  Back to cited text no. 3    
4.Sakuragi N, Takeda N, Hareyama H, Fujimoto T, Todo Y, Okamoto K, et al. Predictors of ovarian and lymph node metastases in patients with cervical carcinoma. Cancer 2003;88:2578-83  Back to cited text no. 4    

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Correspondence Address:
Veena Maheshwari
2/82, Arya Nagar, Avantika Part- 2, Ramghat Road, Aligarh - 202 001, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.41710

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  [Figure 1], [Figure 2]

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