Solitary Vulvar Metastasis from Early Stage Endometrial Cancer: Case Report and Literature Review

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background</jats:bold>Endometrial cancer is the most common gynaecological malignancy in developed countries. It is usually diagnosed at early-stage and presents a favourable prognosis. Conversely, advanced or recurrent disease result in low response to therapy and poor outcome. Most recurrences occur within two years postoperatively, typically in pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs; unusual localizations include abdominal organs/wall, bones, brain, muscle. Vulvar metastasis are indeed anecdotal probably because the different regional lymphatic drainage from corpus uterus. Here, we report a case of vulvar metastasis from an early endometrial cancer comprehensive staged by laparoscopy and reviewed the literature discussing the different mechanisms of vulvar metastasis pathogenesis and the prognosis.<jats:bold>Methods</jats:bold>We reported a case of vulvar metastasis from an early stage endometrial cancer. We also collected and analysed articles written in English regarding vulvar metastasis form endometrial cancer published between January 1966 and May 2020. PubMed was used as a database for this search. Clinical and pathological characteristics, treatments and outcomes were assessed<jats:bold>.</jats:bold>In total, 19 cases of vulvar metastasis from endometrial cancer were found. Patients had a mean age of 66 years and were mostly asymptomatic. Labium major was the most common and usually unique site of metastasis. Vulvar metastasis were mostly nodular/mass-like lesions occurred in patients treated mostly for endometrial cancer at early stage. Median time to vulvar metastasis was ten months. Most of the metastasis were treated with surgery or radiotherapy. One third of patients presented a subsequent recurrence on average 11 months later. 61.1% of patients died of disease and 70 median overall survival was 16 months.Vulvar metastasis can show different appearance, occurring as single or diffuse lesions on healthyor injured skin, in patients treated for both early- and advanced-stage endometrial cancers. Surgicalapproach seems not to influence the risk of subsequent metastasis, but tumor seeding and vaginalinjuries should be avoided. Whether isolated or associated with recurrence in other locations, vulvarmetastasis are characterized by severe prognosis despite radical treatment. Therefore, any suspectedvulvar lesion arisen during endometrial cancer follow-up should be biopsied, despite the vulva represents an unusual metastatic site.<jats:bold>Conclusions</jats:bold>Vulvar metastasis can show different appearance. Surgical approach seems not to influence the risk of subsequent metastasis. Vulvar metastasis are characterized by severe prognosis despite radical treatment. Therefore, any suspected vulvar lesion arisen during follow-up should be biopsied.</jats:p>

Metastatic Neoplasms to the Vulva—A Review

“…9 Features of an additional 18 cases were also summarized. 9 We encountered a case at our institution of a patient who developed metastatic endometrial carcinoma to her vulva, as well as her lower genital tract and lungs, 2 years after suboptimal therapy for her primary tumor in another country. She presented with vaginal bleeding, denuded epithelium, and vulvovaginal swelling extending to the lower limb.…”

“…Case reports have more recently been published further describing vulvar metastatic lesions originating from the endometrium. 8,9 In one case, Giordano et al 8 described a 66-year-old woman who had an EC. The patient underwent a total hysterectomy with bilateral salpingo-oophorectomy.…”

“…On immunohistochemical analysis, the neoplastic cells showed membranous positivity for Ca 125 and nuclear positivity for estrogen and progesterone receptors. 8 Mandato et al 9 described a 73-year-old woman who had an EC. The patient underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, pelvic bilateral lymphadenectomy, as well as undergoing external radiotherapy and vaginal brachytherapy.…”

“…Mismatch repair proteins were found to be positive (normal) too. 9 Features of an additional 18 cases were also summarized. 9 We encountered a case at our institution of a patient who developed metastatic endometrial carcinoma to her vulva, as well as her lower genital tract and lungs, 2 years after suboptimal therapy for her primary tumor in another country.…”