alexa Skin Metastases to Cesarean Scar at Diagnosis of Carcinoma of Cervix in a Postpartum Female | OMICS International
ISSN: 2161-0932
Gynecology & Obstetrics
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Skin Metastases to Cesarean Scar at Diagnosis of Carcinoma of Cervix in a Postpartum Female

Brittany A Davidson, Christa I Nagel and Debra L Richardson*

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center; Dallas, TX, United States

*Corresponding Author:
Debra L Richardson, MD
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology
5323 Harry Hine Blvd, Dallas, TX, United States
Tel: 214-648-3026
Fax: 214-648-8404
E-mail: [email protected]

Received date: October 19, 2015; Accepted date: November 09, 2015; Published date: November 16, 2015

Citation: Davidson BA, Nagel CI, Richardson DL (2015) Skin Metastases to Cesarean Scar at Diagnosis of Carcinoma of Cervix in a Postpartum Female. Cervical Cancer S3:102. doi:10.4172/2161-0932.S3:102

Copyright: © 2015 Davidson BA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Gynecology & Obstetrics

Abstract

Objective: The authors describe the first report of a cesarean scar metastasis at time of diagnosis of cervical cancer in a postpartum female.

Results: We describe the case of a 23 year old multiparous female who is diagnosed with stage IVB cervical cancer 5 months after an emergent cesarean delivery for preterm premature rupture of membranes. At time of diagnosis, she presented with a large cutaneous metastasis at the site of her Pfannenstiel incision. She completed a course of radiation and chemotherapy, however opted for hospice when disease progression was noted after 6 cycles of cisplatin and paclitaxel.

Conclusion: The patient’s disease was likely present at the time of her cesarean section. We recommend thorough pelvic exams in women who present late in pregnancy without prior prenatal care. Though cesarean section is thought to decrease the likelihood of cervical cancer recurrence, it does not completely obviate the risk.

Keywords

Cervical cancer; Pregnancy; Cutaneous metastasis; Cesarean section

Background

Cutaneous metastases may be seen in approximately 2% of visceral tumors, more commonly in cancers of the breast, GI tract, lung and ovary [1]. They are known to have a wide variety of appearances, including nodular, plaque-like or teleangiectatic. Skin involvement is rare in cervical cancer and indicates an advanced disease stage. Most reported cases of cutaneous metastases have been diagnosed at time of recurrence several months (or years) after initial treatment. Skin involvement portends a poor prognosis; death usually follows within 3-6 months [2]. Here we report a case of cutaneous metastasis at time of diagnosis of cervical cancer in a young, postpartum Hispanic female.

Case

Twenty three year old G4P3A1 who initially presented to the emergency department with complaints of fever, nausea & vomiting and lower abdominal pain for several months with concomitant 70 pound weight loss since the birth of her last child five months prior. She had presented to an outside hospital at approximately 27-28 weeks gestation with no prenatal care complaining of copious yellow vaginal discharge. She was diagnosed with preterm premature rupture of membranes for which she underwent an emergent cesarean section. Since that time she continued to have a significant amount of the same discharge. She also noted an enlarging mass at her incision about 1 month prior to presentation. Her last pap smear prior to presentation was one year ago and showed atypical cells of undetermined significance, cannot rule out high grade (ASC-H), after which she was lost to follow up.

In the emergency room she was found to be febrile and tachycardic. On abdominal exam she had a three centimeter superficial, fluctuant and erythematous mass at the lateral border of her Pfannenstiel incision that was draining straw-colored fluid. A larger 5x7cm mass was palpated deep to the superficial mass. On pelvic exam, fungating cervical mass was noted with extension to bilateral pelvic sidewalls. CT scan revealed multiple cystic masses in the subcutaneous tissue of the abdomen with moderate left sided hydronephrosis. Lasix renogram revealed a non-functioning left kidney. Cervical biopsy revealed squamous cell carcinoma and aspiration of the mass in her low transverse incision confirmed metastasis to her skin.

The patient was staged as IVB squamous cell carcinoma of the cervix. Given her extensive symptomatic pelvic disease she was initially treated with palliative pelvic radiation therapy for a total of 5000 cGy delivered in 25 fractions over 50 days, without concurrent cisplatin because of a possible concomitant pelvic tuberculosis diagnosis which was being treated with isoniazid, rifampicin, pyrazinamide, and ethambutol. She had a positive PPD, fevers, and tachycardia. Ultimately, her AFB cultures were negative, and the antibiotics were discontinued. She tolerated pelvic radiation well and went on tochemother receive systemic chemotherapy with cisplatin (50 mg/m2) and paclitaxel (135 mg/m2). She tolerated chemotherapy well and imaging after the first three cycles showed stable disease, however subsequent imaging after cycle six showed disease progression. She declined additional chemotherapy, and opted for supportive care with home hospice. She was on hospice for 8 months before dying of her disease.

Discussion

Cervical cancer is the fourth most common female cancer worldwide with nearly 530,000 new cases and 266,000 deaths in 2012, more than 85% of which occur in less developed nations [3]. The exact incidence of cervical cancer in pregnancy is unknown, but one study has reported an incidence of 1.2 per 10,000 births [4]. This disease provides unique ethical dilemmas in regards to diagnosis, work up and treatment leading to a paucity of data allowing for management guidelines. Postpartum women diagnosed within 6 months of delivery appear to have worse survival outcomes than those diagnosed during pregnancy [5]. Sood et al. reported vaginal delivery as the most significant predictor of disease recurrence in multivariate analysis (odds ratio [OR] 6.91; 95% confidence interval [CI] 1.45-32.8) [5].

Cervical cancer is known to spread primarily by direct extension and through the lymphatics with common sites of distant metastases being lung, bone and liver [6]. Skin metastases have been reported rarely, usually remote from initial presentation and diagnosis. Most of the previously described metastases to skin incisions were recurrences after primary treatment with radical hysterectomy. In 1993, Imachi et al. reviewed a cohort of 1190 women with invasive cervical cancer and found the overall incidence of skin metastases to be ~1.3%; 0.8% in those with Stage I disease and 4.8% in Stage IV. In this study, metastases to skin incisions were excluded [7]. Those with adenocarcinoma were more likely to have cutaneous involvement compared with those with squamous cell carcinoma (5.8% vs. 0.9%). Overall prognosis is poor for these women; eleven of 15 patients died within 24 months of diagnosis of a skin metastasis [7]. Given this patient’s advanced disease at diagnosis, we suspect that her cervical cancer was present at the time of her Cesarean section.

Conclusion

This case represents the first report of cervical cancer initially presenting as skin metastasis to a low transverse incision performed at the time of cesarean section. We recommend considering thorough pelvic exams at the time of delivery for patients who present with limited or no prenatal care. Ideally this would occur at time of presentation to Labor & Delivery in a setting with appropriate lighting and equipment for optimal evaluation. This may have led to an earlier diagnosis for this patient, though it is unclear whether her prognosis would have been altered. If cervical cancer is known to be present at time of Cesarean section, a classical uterine incision should be performed.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

  • 2nd World Congress on Embryology and In Vitro Fertilization March 30-31, 2018 Orlando, USA. Theme: Exploring the Novel Research & Techniques in Reproductive Health
    March 30-31, 2018 Orlando, USA
  • World Congress on Gynecology and Obstetrics
    April 16-17, 2018 Dubai, UAE
  • 7th International Conference on Clinical and Medical Case Reports June 01-02, 2018 Osaka, Japan Theme: Focusing the breakthroughs of case reports in Clinical & Medical Research
    June 01-02, 2018 Osaka, Japan
  • 7th International Conference and Exhibition on Surgery June 21-23, 2018 Dublin, Ireland Theme: Advancements and Endeavours in the Field of Surgery
    June 21-23, 2018 Dublin, Ireland Dublin, Ireland
  • Annual Congress on Research and Innovations in Medicine July 02-03, 2018 Bangkok, Thailand Theme: Current Research and Innovations in Medicine to Improve Human Health
    July 02-03, 2018 Bangkok, Thailand
  • International Conference on Medical and Health Science August 24-25, 2018 Tokyo, JAPAN Theme: Scrutinize the Modish of Medical and Health Science
    August 24-25, 2018 Tokyo, Japan
  • World Summit on Trauma and Reconstructive Surgery Sep 10-11, 2018 Singapore Theme: Expanding new horizons in Trauma and Surgery
    Sep 10-11, 2018 Singapore City, Singapore
  • 6th American Gynecological Surgery Conference September 28-29, 2018 San Antonio | Texas | USA
    September 28-29, 2018 San Antonio, USA
  • World Congress on Fetal and Maternal Medicine October 15-17, 2018 Osaka, Japan Theme: A New Beginning on Fetal, Maternal & Neonatal Medicine
    October 15-17, 2018 Osaka, Japan
  • International Conference on Reproduction and Fertility October 18-19, 2018 Abu Dhabi, UAE
    October 18-19, 2018 Abu Dhabi, UAE

Article Usage

  • Total views: 222
  • [From(publication date):
    specialissue-2015 - Dec 14, 2017]
  • Breakdown by view type
  • HTML page views : 171
  • PDF downloads : 51
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

med[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version