Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case

Abstract

Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.

Keywords: HPV; cervical cancer; hysterectomy; lymph node; metastasis; parietal; radiotherapy.

Figure 1

Schematic description of tumor dissemination pathways.

Figure 2

Intraoperative view during radical hysterectomy. The cervix is adherent to the urinary bladder. U—uterus; UB—urinary bladder (image from video archive of Bucharest Oncological Institute, personal collection of Dr. Marincaș).

Figure 3

Abdomino-pelvin CT scan shows the parietal tumor in the right iliac fossa (yellow circles).

Figure 4

Abdominal CT scan with 3D reconstruction shows the parietal tumor from the right iliac fossa and the left iliac adenopathic block (yellow circles). (R—right, L—Left).

Figure 5

Intraoperative view. The left adenopathic block surrounds the external iliac artery (EIA). SI—small intestine (image from video archive of Bucharest Oncological Institute, personal collection of Dr. Marincaș).

Figure 6

Intraoperative view. The dual mesh prosthesis, with the small intestine below (image from video archive of Bucharest Oncological Institute, personal collection of Dr. Marincaș).

Figure 7

From (a–f) parietal tumor fragments in different magnifications, showing malignant infiltration (adenosquamous carcinoma) with areas of ossification. (Ossification areas—orange circles, glandular tumor cells—green circles, squamous tumor cells—blue circles).