Scalp, skull and brain metastasis of squamous cell carcinoma of the cervix – a rare entity

J. L. Vitorino-Araujo 1 , J. C. E. Veiga 1 , V. R. Barboza 1 , N. de Souza 2 , D. Mayrink 3 , R. F. Nadais 2 & E. G. Figueiredo 4 1 Discipline of Neurosurgery, Santa Casa de S ã o Paulo Medical School, Brazil, 2 Department of Gynecology and Obstetrics, Santa Casa de S ã o Paulo Medical School, Brazil, 3 Department of Pathology, Santa Casa de S ã o Paulo Medical School, Brazil, and 4 Division of Neurosurgery, University of S ã o Paulo, Brazil

Abstract Metastasis of squamous cell carcinoma of the uterine cervix on the scalp has been reported only six times in the literature; however, we found no reports of metastasis on the scalp associated with skull and brain invasion. We present an exceptionally rare case with good evolution after neurosurgical resection.

 

Case report

A 55-year-old lady, with a history of squamous cell carcinoma of cervix, stage TIIIB, developed bulging of the left fronto-temporo-parietal region with dimensions of 10.5 7.0 cm in July 2011. Brain MRI revealed expansive process in the region of the scalp with skull and brain invasion (Fig. 1). Th e patient underwent excision of the scalp and infi ltrated bone followed by “ en bloc ” resection of the dura mater, anterior segment of the superior sagittal sinus, cerebral falx and neoplasm invading the left frontal region (Fig. 2). We performed duraplasty with fascia lata, and the cutaneous closing was performed with a pediculated skin fl ap from the right superfi cial temporal artery and skin graft from the lateral side of the left thigh. Th e patient showed satisfactory evolution in the postoperative period, with no motor or sensory defi cits. Histological examination showed an epidermoid carcinoma of the cervix. Th e patient is currently under follow-up with no evidence of local recurrence.

Discussion

Cancer of the cervix is the second most common malignancy in women worldwide and the most frequent type of cancer in women in many developing countries. 1 – 3 Dissemination usually occurs by contiguous spread or through the lymphatic system. 1 – 3 Haematogenous dissemination is infrequent, occurring in advanced stages of the disease, especially to the lung, liver, bones and extrapelvic lymph nodes. 1 – 3 There are isolated reports of occurrence

of distant metastases at unusual sites such as orbit, brain, breast, heart, thyroid, kidney, spleen, intestine, muscle and skin from cervical cancer. 1 – 3 Skin metastasis of squamous cell carcinoma of the uterine cervix is rare, and the skin of the abdomen and of the lower limbs is usually the aff ected places, possibly due to proximity to the primary site. 1,2 Th ere is evidence that the primary form of dissemination to the skin is through the lymphatic system. 1 Metastasis on the scalp is very rare, and has been previously reported in only six studies. 1 – 3 Dissemination probably occurs through the haematogenic pathway and through tumour emboli that reach the external carotid artery branches, with consequent local implantation. 2 In all reported cases, the treatment was palliative, with radiotherapy being used for local control. 1 – 3 In the present study, we report a new case of metastatic carcinoma of the cervix with scalp, skull and brain invasion, with no evidence of metastases in the lungs or liver. Surgical resection of the lesion aimed at the treatment of the established intracranial hypertension and neoplastic cytoreduction, with the aim of promoting better response to the adjuvant radiotherapy. Scalp metastasis in squamous cell carcinoma of the cervix is exceptionally rare and treatment should be individualized, aiming at symptom control and improved quality of life.

 

Declaration of interest: The authors report no declarations of interest. Th e authors alone are responsible for the content and writing of the paper.

References

1. Maheshwari G , Baboo H , Ashwathkumar R , Dave K , Wadhwa M . Scalp Metastasis from squamous cell carcinoma of the cervix . Int J Gynecol Cancer 2001 ; 11 : 244 – 6 . 2. Agarwal U , Dahiya P , Chauhan A , Sangwan K , Purwar P . Scalp Metastasis in carcinoma of the uterine cervix – a rare entity . Gynecol Oncol 2002 ; 87 : 310 – 12 . 3. Takagi H , Miura S , Matsunami K , Ikeda T , Imai A . Cervical c â ncer metastasis to the scalp: case report and literature review . Eur J Gynaec Oncol 2010 ; 31 : 217 – 8 .

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