Intra Luminal Metastasis to Duodenum: A Histological Surprise

Abstract

Carcinoma cervix is one of the most common malignancies seen in women worldwide and more so in the Indian subcontinent. Carcinoma cervix is known for its orderly lymphatic spread. Skip metastasis or intraluminal metastasis is not a frequent occurrence. A 50-year-old diabetic and hypertensive female patient who was diagnosed to have carcinoma cervix (stage II A 2) Grade II to III and post radiotherapy (3 years back) presented to the surgical outpatient with dyspeptic symptoms and vague abdominal pain. On examination she was found to have a 1x1cm hard, fixed, left supraclavicular node and a palpable liver. Ultrasound abdomen revealed multiple retro peritoneal lymphadenopathy and Contrast Enhanced Computerised Tomography (CECT) abdomen revealed secondary deposits in the pancreatico-duodenal groove infiltrating the duodenal C-loop and pancreatic head, with multiple retroperitoneal nodes with necrosis. Fine needle Aspiration Cytology (FNAC) from left supraclavicular node revealed metastatic squamous cell carcinoma. Oesophagogastroduodenoscopy showed 2 sessile lesions in the anterior wall of duodenum with mucosa stretched and central umbilication with almost complete luminal obstruction. Biopsy from the duodenal lesion also turned out positive for metastatic squamous cell carcinoma. Gynaecological examination was negative for any local recurrence. Patient was managed symptomatically for dyspepsia and is currently undergoing chemotherapy. She is at present on regular follow-up and is asymptomatic for the bowel metastasis. Given the frequency of cancer cervix and the rarity of intra luminal metastasis, this case report serves to reiterate the fact that the abdomen is truly a pandora's box.

Metastases to duodenum in cervical squamous cell carcinoma

“…A comprehensive review of published cases of duodenal metastases from SCC of the cervix in the English literature dating back to 1981 is provided in Table 1. [10][11][12][13][14][15][16] As shown in Table 1, since 1981, even with our report, only 8 cases of duodenal metastasis of cervical cancer have been reported. It is worth noting that the interval time to metastases in our cases was significantly higher than in the others, which may be due to the earlier stage of SCC of the cervix or the suppression of tumor cells by the previous treatment of hysterectomy and radiation therapy.…”

“…Cervical cancer metastasis to the duodenum is rare. A comprehensive review of published cases of duodenal metastases from SCC of the cervix in the English literature dating back to 1981 is provided in Table 1 [10–16] . As shown in Table 1, since 1981, even with our report, only 8 cases of duodenal metastasis of cervical cancer have been reported.…”