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Case Reports
. 2025 Jan 4;17(1):e76924.
doi: 10.7759/cureus.76924. eCollection 2025 Jan.

Multiple Subcutaneous Metastases in Endometrial Cancer Treated With Systemic Chemotherapy: A Case Report and Review of the Literature

Ryo Higashide  1   2 , Seiichi Endo  1 , Mayu Akita  1 , Nanami Kawakami  1 , Koji Shimabukuro  1
Affiliations
Case Reports

Multiple Subcutaneous Metastases in Endometrial Cancer Treated With Systemic Chemotherapy: A Case Report and Review of the Literature

Ryo Higashide et al. Cureus. .

Abstract

Subcutaneous metastasis of endometrial cancer (EC) is an exceedingly rare phenomenon, and the mechanisms underlying its pathogenesis remain insufficiently elucidated. We report the case of a 69-year-old multiparous woman diagnosed with stage IB EC, histologically classified as grade 3 endometrioid and clear cell carcinoma. Approximately one month following primary surgical intervention, the patient developed subcutaneous masses on her back, axilla, and buttock. Histopathological evaluation, in conjunction with PET-CT, confirmed a systemic recurrence of EC. She was subsequently treated with a combination of paclitaxel and carboplatin, with a remarkable therapeutic response; after six cycles of chemotherapy, nearly all metastatic sites exhibited complete resolution. She was then transitioned to a regimen of lenvatinib and pembrolizumab. However, one week after the initiation of this treatment, she developed hepatic encephalopathy, which was presumed to be lenvatinib-induced, and was successfully managed with aminoleban injections, resulting in a full recovery of consciousness. Follow-up diagnostic imaging confirmed a complete response to therapy. The patient is currently receiving pembrolizumab as maintenance therapy and has remained recurrence-free for 18 months. While no standardized therapeutic protocol exists for the management of subcutaneous metastasis in EC due to its extremely low incidence, this report provides evidence for the potential efficacy of chemotherapy combined with targeted immunotherapy in the treatment of unresectable subcutaneous metastases in EC.

Keywords: clear cell carcinoma; endometrial cancer (ec); endometrioid carcinoma; lenvatinib-induced hepatic encephalitis; msi-high; subcutaneous metastasis; tmb-high.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative imaging
(a) A contrast-enhanced CT scan of the pelvis reveals a mass localized to the uterus, with no evidence of metastatic involvement (red arrowhead). (b) A T2-weighted MRI of the pelvis demonstrates a tumor confined to the uterine corpus, with an estimated invasion extending beyond 50% of the myometrium (red arrowhead) CT: computed tomography; MRI: magnetic resonance imaging
Figure 2
Figure 2. Postoperative PET-CT imaging one month after primary surgery
(a) FDG uptake is observed diffusely throughout the body. (b) FDG uptake is noted in the left posterior thoracic region. (c) FDG uptake is identified in the left axillary region. (d) FDG uptake is seen in the left buttock region. All subcutaneous metastases were palpable upon physical examination FDG: 18F-fluorodeoxyglucose; PET-CT: positron emission tomography-computed tomography
Figure 3
Figure 3. CT images showing response to chemotherapy
The upper row displays pre-treatment images, while the lower row presents post-treatment images following three cycles of paclitaxel and carboplatin. A nearly complete resolution of all metastatic lesions is observed. Red arrows indicate subcutaneous metastases CT: computed tomography
See this image and copyright information in PMC

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