Rare case report: Liver metastasis from cervical adenocarcinoma presenting with cystic mass and obstructive jaundice

Abstract

Liver metastases can originate from primary tumors in various organs; however, metastasis from cervical cancer to the liver is rare. Cervical cancer patients with distant metastases have a poor prognosis and reduced survival rates. This report describes a case of a cystic liver mass with obstructive jaundice, observed four years after resection of cervical adenocarcinoma. The lesion lacked typical imaging characteristics of hepatic metastases and was initially suspected to be a biliary neoplasm. A contrast-enhanced, ultrasound-guided needle biopsy was performed to confirm the diagnosis. Histopathological analysis confirmed adenocarcinoma of the liver, and immunohistochemical staining suggested a uterine or adnexal origin. Considering the patient's surgical history, the final diagnosis was liver metastasis originating from cervical adenocarcinoma. This report reviews relevant literature to discuss the clinical features, diagnostic challenges, and therapeutic strategies for liver metastasis of cervical cancer.

Keywords: case report; cervical cancer; contrast-enhanced ultrasound; hepatic cystic neoplasms; liver metastases.

Figure 1

Imaging and histopathological features of a hepatic mass in a 48-year-old patient. (A, B) Contrast-enhanced CT scans demonstrate a hypodense lesion in the right hepatic lobe with peripheral ring enhancement and non-enhancing core, associated with intrahepatic bile duct dilation (white arrow). (C, D) Contrast-enhanced MRI shows a thick-walled cystic lesion in the right hepatic lobe with peripheral ring enhancement (white arrow). (E, F) Ultrasound examination shows a cystic-solid mass with ill-defined margins; color Doppler imaging demonstrates no detectable intralesional blood flow (white arrow). (G, H) Contrast-enhanced ultrasound reveals rapid thin peripheral hyperenhancement without washout and absence of internal enhancement (white arrow). (I, J) Ultrasound-guided cyst aspiration using a 17G coaxial needle extracted 40 mL of dark-green viscous fluid (white arrow). (K, L) Subsequent core needle biopsies from the mass periphery and central region were obtained using an 18G semi-automatic device to collect three tissue cores (white arrow). (M) Cytological examination of the cystic fluid shows a few atypical keratinized cells in the cystic background (H&E staining, 200x), (white arrow). (N) Histological section shows tumor cells arranged in nests with marked nuclear pleomorphism, irregular contours, and hyperchromasia (H&E staining, 200x), (white arrow). (O) Immunohistochemical staining for CA125 shows positive membranous expression in cancer cells (EnVision staining, 200x). (P) Immunohistochemical staining for CK7 shows positive cytoplasmic expression in cancer cells (EnVision staining, 200x).

Figure 2

Serial imaging evaluation of tumor progression following chemotherapy completion. (A) after 4 cycles of chemotherapy, size of the tumor: 52 mm x 48 mm (white arrow). (B) 3 months post-chemotherapy, size of the tumor: 67mm x 64 mm (white arrow). (C) 6 months post-chemotherapy, size of the tumor: 86 mm x 84 mm (white arrow). (D) 9 months post-chemotherapy, size of the tumor: 109 mm x 106 mm (white arrow).