Uterine cervical squamous cell carcinoma with duodenal metastasis causes obstructive jaundice

Abstract

Summary This 73‐year‐old female had undergone right middle lobe lobectomy for adenocarcinoma of lung (pT2N0M0) and got cured without recurrence. However, two years later, she was diagnosed as another cancer, uterine cervical squamous cell carcinoma (the International Federation of Gynecology and Obstetrics stage IIB), and received a series of concurrent chemoradiotherapy (CCRT). After 6 months of CCRT, she was admitted due to abdominal pain and nausea for one week. Physical examination disclosed mild epigasrtic tenderness and icteric sclera. Upper gastrointestinal endoscopy showed friable mucosa and narrowed lumen over the 2nd portion of duodenum, and the result of biopsy confirmed metastatic carcinoma of uterine cervix by positive for P16 immunohistochemically. Moreover, abdominal computed tomography (CT) scan disclosed increased infiltrative soft tissue at pancreatic head, uncinate process, pancreaticoduodenal groove, with eccentric thickening of the wall of bulb to 1st – 2nd portion of duodenum. The diagnosis was made as uterine cervical squamous cell carcinoma with duodenal metastasis and intestinal obstruction. The patient received supportive care. However, she died due to sepsis about one month later. Small intestinal neoplasm is rare and adenocarcinoma is more prevalent than other types of tumors. Common metastatic sites of uterine cervical cancer are the liver, lung, and bone marrow. Small intestine metastasis is found only in about 1.5 – 5.3% of patients with uterine cervical carcinoma beyond stage IIA. The presentation of patients with duodenal metastasis varies from epigastric pain, upper gastrointestinal hemorrhage to intestinal obstruction. Diagnosis is difficult and dependent on high alert of clinical physicians. Upper gastrointestinal endoscopy, CT scan or endoscopic retrograde cholangiopancreatography could be used to detect obstructive lesion, but the diagnosis is only made by biopsy with immunohistochemical stain. However, to diagnose it correctly and instantly is important because long term prognosis of patients with duodenal metastases is extremely poor without effective treatment. The pearl of this case is that clinical physician should keep alert for small intestinal neoplasm, even the flat type, in the patients who have history of other primary malignancy, such as cervical cancer. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.