Abstract. Background Cervical cancer remains one of the most common gynecologic malignancies worldwide; although association of oncologic treatment is widely performed, a number of cases will develop, at a certain moment, distant metastases (1, 2). Unfortunately, most patients in this situation will be diagnosed with disseminated secondary lesions, being candidates only for palliative treatment. In rare cases, solitary metastases have been reported, transforming the patient into the perfect candidate for re-operation. We present the case of a 31-year-old patient diagnosed with an isolated splenic recurrence 18 months after surgically-treated cervical cancer. Case ReportWe present the case of a 31-year-old patient who initially presented to our service for pelvic pain and massive vaginal bleeding. At that moment, a cervical biopsy revealed the presence of a moderately differentiated squamous cell cervical cancer. The preoperative investigations revealed a stage IIB cervical tumor, so the patient was submitted to neoadjuvant chemotherapy and radiation therapy followed by surgery; a total radical hysterectomy en bloc, with bilateral adnexectomy and pelvic lymph node dissection was performed. The histopathological studies confirmed the presence of an area of 5 mm with 4-mm deep invasion with malignant transformation; in the meantime, the histopathological evaluation of the lymph nodes revealed the absence of tumoral invasion in none of the retrieved lymph nodes (eleven left side lymph nodes and seven right side lymph nodes). These findings classified the lesion as a T1a2, pN0, M0 cervical cancer. At 18 months follow-up, the patient was diagnosed with an isolated tumoral mass of 5/5 cm located in the splenic hylum, so the patient was re-operated. Intraoperatively, the diagnostic of solitary splenic lesion was confirmed, so the patient was submitted to splenectomy (Figures 1-5). The postoperative course was uneventful, with the patient being discharged in the fifth postoperative day. The histopathological study revealed the presence of a 5/5 cm lesion with a typical aspect of a splenic metastasis of a moderately differentiated squamous cell cervical cancer. One month after discharge, the patient was submitted to adjuvant chemotherapy consisting of six cycles of cisplatin and paclitaxel. At one year follow-up, the patient is free of any recurrent disease or distant metastases. DiscussionCervical cancer has a high propensity of local spread, after destroying the natural compartmental borders, leading to the apparition of pelvic masses involving the urinary bladder and/or 2615

Abstract. Gestational Association between positive β-hCG, pelvic pain and parauterine mass in a reproductive age female is most often associated with ectopic pregnancy and necessitates emergency treatment in order to stop the evolution of the pregnancy. However, β-hCG can be secreted by neoplastic cells such as malignant ovarian germ cells tumors, gestational trophoblastic disease or teratomas (1). Case ReportA 19-year-old grade 1 patient presented for pelvic pain and vaginal bleeding; she was submitted to a transvaginal ultrasonography which demonstrated the presence of a 5/4/5 cm left parauterine mass in association with increased levels of β-hCG, and with an empty uterine cavity so she was counseled for either conservative or surgical treatment. She opted for surgery, so a laparoscopic exploration of the peritoneal cavity was performed. Intraoperatively the fallopian tube presented a tumoral aspect, so a left salpingectomy was performed. The histopathological studies revealed the presence of a gestational choriocarcinoma. Postoperatively the patient was submitted to adjuvant treatment with methotrexate; however, after the second administration of this agent the high serum levels of β-hCG persisted, so it was considered to be methotrexate resistant. A second line therapy with dactinomycin was initiated, two courses being administrated. At six month follow-up, higher values of β-hCG were observed so a pelvic MRI was performed. At this time the patient was diagnosed with a large pelvic tumor invading the rectosigmoidian wall so she was re-submitted to surgery, cytoreduction to no residual disease being obtained; at this moment a rectosigmoidian resection en bloc with total hysterectomy and right adnexectomy were performed in order to achieve a good local control of the disease (Figures 1-4). The anatomo-pathological studies confirmed the same histologic origin of the tumor. The postoperative course was uneventful, the patient being discharged in the sixth postoperative day. At six months follow-up she is free of recurrent disease. DiscussionThe association of a para-uterine mass in the presence of elevated β-hCG levels and empty uterine cavity in fertile women is usually strongly suggestive for ectopic pregnancy. In 423

No abstract

No abstract

No abstract