EP358\u2005Rare case of an uterine cervix metastasis from a sigmoid adenocarcinoma

Abstract

Introduction/Background Primary adenocarcinoma of the cervix uteri accounts for 5% to 15% of all malignancies of the cervix uteri. Uterine cervix metastases from carcinomas over the hematogenous or lymphatic pathway are rare. The most frequent non-genital primary sites of adenocarcinomasare stomach and colon. Methodology Case report. Results A 49-year-old female patient presented with pelvic pain. The gynecological examination showed a well-defined, non-deforming, but ulcerating tumor mass (2.5 cm) on the cervix uteri. The border between squamous and columnar epithelium was not visible on colposcopy, according to T3. Obviously, the lesion had no reference to the transformation zone. By biopsy, an adenocarcinoma was diagnosed. Subsequent immunohistochemical examination revealed a strong nuclear staining of CDX2 and CK20. This indicated a primary tumor site in the gastrointestinal tract. Colonoscopy detected a stenosing tumor of the sigmoid colon. Due to increased abdominal symptoms, urgent laparotomy was performed. Intraoperative, the primary tumor site in the sigmoid colon was confirmed. Because of multiple metastases (liver, adnexa, lung, omentum), palliative chemotherapy was indicated. Evidence of microsatellite instability could not be demonstrated. At follow-up, 1.5 years later, the patient showed progression of liver and lung lesions. Further therapy included selective internal radiotherapy and oral therapy with Trifluridine/Tipiracil. Conclusion The case shows a rare uterine cervix metastasis from a sigmoid adenocarcinoma. Typical character is the recess of the transformation zone. Therefore, the colposcopic image in this case is untypical for primary cervical carcinoma. Management should be adjusted according to the tumor origin. Disclosure An image quote about this case was published in the journal ‘FRAUENARZT’ in March 2018.