Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2019

Open Access 01-12-2019 | Metastasis | Case report

Pathologically confirmed brain metastases from primary uterine cervical tumors: two cases and a literature review

Authors: Yalan Bi, Lei Li

Published in: World Journal of Surgical Oncology | Issue 1/2019

Login to get access

Abstract

Background

Pathologically confirmed brain metastasis from primary cervical cancer is extremely rare. Herein, we report two cases of intracranial metastasis from cervical cancer that were histopathologically confirmed after surgical excision. In addition, we conducted a literature review to characterize the clinical manifestation, pathogenesis, and treatment of these patients.

Case summary

Among the 1800 patients with primary cervical cancer who received therapy at our center from 2010 to 2018, two patients (0.1%) had definite histopathological evidence of brain metastasis. A 46-year-old female who had a history of poorly differentiated stage IIB cervical cancer with neuroendocrine differentiation presented with a solitary mass in the right occipital lobe 26 months after the initial diagnosis. She underwent surgery and chemotherapy but died of disease progression 9 months later. Another 55-year-old female diagnosed with poorly differentiated stage IVB cervical squamous cancer presented with a solitary mass in the right frontal lobe 16 months after simple hysterectomy. Twelve months later, multiple lesions were observed in the bilateral frontal-parietal lobe. The lesions were treated by surgery and stereotactic radiosurgery. The patient died of multiple organ failure 14 months later.

Conclusion

The pathogenesis and best management of brain metastasis from cervical cancer are not clear. Highly invasive subtypes or advanced cancer stages may be the key clinicopathological factors of brain metastasis. Surgical treatment is warranted in patients with a good health status and without metastasis to other sites.
Literature
1.
go back to reference Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRefPubMed Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRefPubMed
2.
go back to reference van Meir H, Kenter GG, Burggraaf J, et al. The need for improvement of the treatment of advanced and metastatic cervical cancer, the rationale for combined chemo-immunotherapy. Anti Cancer Agents Med Chem. 2014;14(2):190–203.CrossRef van Meir H, Kenter GG, Burggraaf J, et al. The need for improvement of the treatment of advanced and metastatic cervical cancer, the rationale for combined chemo-immunotherapy. Anti Cancer Agents Med Chem. 2014;14(2):190–203.CrossRef
4.
go back to reference Agrawal A, Kumar A, Sinha AK, et al. Intracranial metastases from carcinoma of the cervix. Singap Med J. 2007;48(5):e154–6. Agrawal A, Kumar A, Sinha AK, et al. Intracranial metastases from carcinoma of the cervix. Singap Med J. 2007;48(5):e154–6.
5.
6.
go back to reference Divine LM, Kizer NT, Hagemann AR, et al. Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol. 2016;142(1):76–82.CrossRefPubMedPubMedCentral Divine LM, Kizer NT, Hagemann AR, et al. Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol. 2016;142(1):76–82.CrossRefPubMedPubMedCentral
7.
8.
go back to reference Peters P, Bandi H, Efendy J, et al. Rapid growth of cervical cancer metastasis in the brain. J Clin Neurosci. 2010;17(9):1211–2.CrossRefPubMed Peters P, Bandi H, Efendy J, et al. Rapid growth of cervical cancer metastasis in the brain. J Clin Neurosci. 2010;17(9):1211–2.CrossRefPubMed
9.
go back to reference Chung SB, Jo KI, Seol HJ, et al. Radiosurgery to palliate symptoms in brain metastases from uterine cervix cancer. Acta Neurochir. 2013;155(3):399–405.CrossRefPubMed Chung SB, Jo KI, Seol HJ, et al. Radiosurgery to palliate symptoms in brain metastases from uterine cervix cancer. Acta Neurochir. 2013;155(3):399–405.CrossRefPubMed
10.
go back to reference Chura JC, Shukla K, Argenta PA. Brain metastasis from cervical carcinoma. Int J Gynecol Cancer. 2007;17(1):141–6.CrossRefPubMed Chura JC, Shukla K, Argenta PA. Brain metastasis from cervical carcinoma. Int J Gynecol Cancer. 2007;17(1):141–6.CrossRefPubMed
11.
go back to reference Schoggl A, Kitz K, Reddy M, et al. Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir. 2000;142(6):621–6.CrossRefPubMed Schoggl A, Kitz K, Reddy M, et al. Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir. 2000;142(6):621–6.CrossRefPubMed
12.
go back to reference Al-Shamy G, Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neuro-Oncol. 2009;92(3):275–82.CrossRef Al-Shamy G, Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neuro-Oncol. 2009;92(3):275–82.CrossRef
14.
15.
16.
go back to reference Lefkowitz D, Asconape J, Biller J. Intracranial metastases from carcinoma of the cervix. South Med J. 1983;76(4):519–21.CrossRefPubMed Lefkowitz D, Asconape J, Biller J. Intracranial metastases from carcinoma of the cervix. South Med J. 1983;76(4):519–21.CrossRefPubMed
17.
go back to reference Nasu K, Satoh T, Nishio S, et al. Clinicopathologic features of brain metastases from gynecologic malignancies: a retrospective study of 139 cases (KCOG-G1001s trial). Gynecol Oncol. 2013;128(2):198–203.CrossRefPubMed Nasu K, Satoh T, Nishio S, et al. Clinicopathologic features of brain metastases from gynecologic malignancies: a retrospective study of 139 cases (KCOG-G1001s trial). Gynecol Oncol. 2013;128(2):198–203.CrossRefPubMed
18.
go back to reference Buchsbaum HJ, Rice AC. Cerebral metastasis in cervical carcinoma. Am J Obstet Gynecol. 1972;114(2):276–8.CrossRefPubMed Buchsbaum HJ, Rice AC. Cerebral metastasis in cervical carcinoma. Am J Obstet Gynecol. 1972;114(2):276–8.CrossRefPubMed
19.
go back to reference Cordeiro JG, Prevedello DM, da Silva Ditzel LF, et al. Cerebral metastasis of cervical uterine cancer: report of three cases. Arq Neuropsiquiatr. 2006;64(2A):300–2.CrossRefPubMed Cordeiro JG, Prevedello DM, da Silva Ditzel LF, et al. Cerebral metastasis of cervical uterine cancer: report of three cases. Arq Neuropsiquiatr. 2006;64(2A):300–2.CrossRefPubMed
20.
go back to reference Noh T, Walbert T. Brain metastasis: clinical manifestations, symptom management, and palliative care. Handb Clin Neurol. 2018;149:75–88.CrossRefPubMed Noh T, Walbert T. Brain metastasis: clinical manifestations, symptom management, and palliative care. Handb Clin Neurol. 2018;149:75–88.CrossRefPubMed
21.
go back to reference Raza M, Prasad P, Gupta P, et al. Perspectives on the role of brain cellular players in cancer-associated brain metastasis: translational approach to understand molecular mechanism of tumor progression. Cancer Metastasis Rev. 2018;37(4):791–804.CrossRefPubMed Raza M, Prasad P, Gupta P, et al. Perspectives on the role of brain cellular players in cancer-associated brain metastasis: translational approach to understand molecular mechanism of tumor progression. Cancer Metastasis Rev. 2018;37(4):791–804.CrossRefPubMed
23.
25.
go back to reference Chen EI, Hewel J, Krueger JS, et al. Adaptation of energy metabolism in breast cancer brain metastases. Cancer Res. 2007;67(4):1472–86.CrossRefPubMed Chen EI, Hewel J, Krueger JS, et al. Adaptation of energy metabolism in breast cancer brain metastases. Cancer Res. 2007;67(4):1472–86.CrossRefPubMed
26.
go back to reference Chen J, Lee HJ, Wu X, et al. Gain of glucose-independent growth upon metastasis of breast cancer cells to the brain. Cancer Res. 2015;75(3):554–65.CrossRefPubMed Chen J, Lee HJ, Wu X, et al. Gain of glucose-independent growth upon metastasis of breast cancer cells to the brain. Cancer Res. 2015;75(3):554–65.CrossRefPubMed
27.
go back to reference Mahmoud-Ahmed AS, Suh JH, Barnett GH, et al. Tumor distribution and survival in six patients with brain metastases from cervical carcinoma. Gynecol Oncol. 2001;81(2):196–200.CrossRefPubMed Mahmoud-Ahmed AS, Suh JH, Barnett GH, et al. Tumor distribution and survival in six patients with brain metastases from cervical carcinoma. Gynecol Oncol. 2001;81(2):196–200.CrossRefPubMed
28.
go back to reference Hwang JH, Yoo HJ, Lim MC, et al. Brain metastasis in patients with uterine cervical cancer. J Obstet Gynaecol Res. 2013;39(1):287–91.CrossRefPubMed Hwang JH, Yoo HJ, Lim MC, et al. Brain metastasis in patients with uterine cervical cancer. J Obstet Gynaecol Res. 2013;39(1):287–91.CrossRefPubMed
29.
go back to reference Cacho-Diaz B, Lorenzana-Mendoza NA, Michel-Ortega RM, et al. Central nervous system metastases in patients with cervical carcinoma. Int J Gynecol Cancer. 2016;26(9):1686–9.CrossRefPubMed Cacho-Diaz B, Lorenzana-Mendoza NA, Michel-Ortega RM, et al. Central nervous system metastases in patients with cervical carcinoma. Int J Gynecol Cancer. 2016;26(9):1686–9.CrossRefPubMed
30.
go back to reference Lan-Fang L, Hai-Yan S, Zuo-Ming Y, et al. Small cell neuroendocrine carcinoma of the cervix: analysis of the prognosis and role of radiation therapy for 43 cases. Eur J Gynaecol Oncol. 2012;33(1):68–73.PubMed Lan-Fang L, Hai-Yan S, Zuo-Ming Y, et al. Small cell neuroendocrine carcinoma of the cervix: analysis of the prognosis and role of radiation therapy for 43 cases. Eur J Gynaecol Oncol. 2012;33(1):68–73.PubMed
31.
go back to reference Komiyama S, Nishio E, Torii Y, et al. A case of primary uterine cervical neuroendocrine tumor with meningeal carcinomatosis confirmed by diagnostic imaging and autopsy. Int J Clin Oncol. 2011;16(5):581–6.CrossRefPubMed Komiyama S, Nishio E, Torii Y, et al. A case of primary uterine cervical neuroendocrine tumor with meningeal carcinomatosis confirmed by diagnostic imaging and autopsy. Int J Clin Oncol. 2011;16(5):581–6.CrossRefPubMed
32.
go back to reference Yoon A, Choi CH, Kim HJ, et al. Contributing factors for bone metastasis in uterine cervical cancer. Int J Gynecol Cancer. 2013;23(7):1311–7.CrossRefPubMed Yoon A, Choi CH, Kim HJ, et al. Contributing factors for bone metastasis in uterine cervical cancer. Int J Gynecol Cancer. 2013;23(7):1311–7.CrossRefPubMed
33.
go back to reference Zhang Y, Guo X, Wang G, et al. Real-world study of the incidence, risk factors, and prognostic factors associated with bone metastases in women with uterine cervical cancer using Surveillance, Epidemiology, and End Results (SEER) data analysis. Med Sci Monit. 2018;24:6387–97.CrossRefPubMedPubMedCentral Zhang Y, Guo X, Wang G, et al. Real-world study of the incidence, risk factors, and prognostic factors associated with bone metastases in women with uterine cervical cancer using Surveillance, Epidemiology, and End Results (SEER) data analysis. Med Sci Monit. 2018;24:6387–97.CrossRefPubMedPubMedCentral
34.
go back to reference Kodama J, Seki N, Nakamura K, et al. Prognostic factors in pathologic parametrium-positive patients with stage IB-IIB cervical cancer treated by radical surgery and adjuvant therapy. Gynecol Oncol. 2007;105(3):757–61.CrossRefPubMed Kodama J, Seki N, Nakamura K, et al. Prognostic factors in pathologic parametrium-positive patients with stage IB-IIB cervical cancer treated by radical surgery and adjuvant therapy. Gynecol Oncol. 2007;105(3):757–61.CrossRefPubMed
35.
go back to reference Hatiboglu MA, Tuzgen S, Akdur K, et al. Treatment of high numbers of brain metastases with gamma knife radiosurgery: a review. Acta Neurochir. 2016;158(4):625–34.CrossRefPubMed Hatiboglu MA, Tuzgen S, Akdur K, et al. Treatment of high numbers of brain metastases with gamma knife radiosurgery: a review. Acta Neurochir. 2016;158(4):625–34.CrossRefPubMed
36.
go back to reference Churilla TM, Handorf E, Collette S, et al. Whole brain radiotherapy after stereotactic radiosurgery or surgical resection among patients with one to three brain metastases and favorable prognoses: a secondary analysis of EORTC 22952-26001. Ann Oncol. 2017;28(10):2588–94.CrossRefPubMedPubMedCentral Churilla TM, Handorf E, Collette S, et al. Whole brain radiotherapy after stereotactic radiosurgery or surgical resection among patients with one to three brain metastases and favorable prognoses: a secondary analysis of EORTC 22952-26001. Ann Oncol. 2017;28(10):2588–94.CrossRefPubMedPubMedCentral
37.
go back to reference Soffietti R, Ruda R, Trevisan E. Brain metastases: current management and new developments. Curr Opin Oncol. 2008;20(6):676–84.CrossRefPubMed Soffietti R, Ruda R, Trevisan E. Brain metastases: current management and new developments. Curr Opin Oncol. 2008;20(6):676–84.CrossRefPubMed
38.
go back to reference Baumert BG, Rutten I, Dehing-Oberije C, et al. A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys. 2006;66(1):187–94.CrossRefPubMed Baumert BG, Rutten I, Dehing-Oberije C, et al. A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys. 2006;66(1):187–94.CrossRefPubMed
40.
go back to reference Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60.CrossRefPubMedPubMedCentral Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60.CrossRefPubMedPubMedCentral
41.
go back to reference Queirolo P, Spagnolo F, Ascierto PA, et al. Efficacy and safety of ipilimumab in patients with advanced melanoma and brain metastases. J Neuro-Oncol. 2014;118(1):109–16. Queirolo P, Spagnolo F, Ascierto PA, et al. Efficacy and safety of ipilimumab in patients with advanced melanoma and brain metastases. J Neuro-Oncol. 2014;118(1):109–16.
42.
go back to reference Knisely JP, Yu JB, Flanigan J, et al. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117(2):227–33.CrossRefPubMedPubMedCentral Knisely JP, Yu JB, Flanigan J, et al. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117(2):227–33.CrossRefPubMedPubMedCentral
43.
go back to reference Goldberg SB, Gettinger SN, Mahajan A, et al. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol. 2016;17(7):976–83.CrossRefPubMedPubMedCentral Goldberg SB, Gettinger SN, Mahajan A, et al. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol. 2016;17(7):976–83.CrossRefPubMedPubMedCentral
44.
go back to reference Vecht CJ, Haaxma-Reiche H, Noordijk EM, et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol. 1993;33(6):583–90.CrossRefPubMed Vecht CJ, Haaxma-Reiche H, Noordijk EM, et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol. 1993;33(6):583–90.CrossRefPubMed
45.
go back to reference Tangjitgamol S, Levenback CF, Beller U, et al. Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer. 2004;14(3):399–422.CrossRefPubMed Tangjitgamol S, Levenback CF, Beller U, et al. Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer. 2004;14(3):399–422.CrossRefPubMed
46.
go back to reference Wronski M, Arbit E, McCormick B. Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer. 1997;80(9):1746–54.CrossRefPubMed Wronski M, Arbit E, McCormick B. Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer. 1997;80(9):1746–54.CrossRefPubMed
47.
go back to reference Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.CrossRefPubMed Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.CrossRefPubMed
48.
go back to reference Hayashi N, Takahashi H, Hasegawa Y, et al. A nationwide multi-institutional retrospective study to identify prognostic factors and develop a graded prognostic assessment system for patients with brain metastases from uterine corpus and cervical cancer. BMC Cancer. 2017;17(1):397.CrossRefPubMedPubMedCentral Hayashi N, Takahashi H, Hasegawa Y, et al. A nationwide multi-institutional retrospective study to identify prognostic factors and develop a graded prognostic assessment system for patients with brain metastases from uterine corpus and cervical cancer. BMC Cancer. 2017;17(1):397.CrossRefPubMedPubMedCentral
49.
go back to reference Kim YZ, Kwon JH, Lim S. A clinical analysis of brain metastasis in gynecologic cancer: a retrospective multi-institute analysis. J Korean Med Sci. 2015;30(1):66–73.CrossRefPubMed Kim YZ, Kwon JH, Lim S. A clinical analysis of brain metastasis in gynecologic cancer: a retrospective multi-institute analysis. J Korean Med Sci. 2015;30(1):66–73.CrossRefPubMed
Metadata
Title
Pathologically confirmed brain metastases from primary uterine cervical tumors: two cases and a literature review
Authors
Yalan Bi
Lei Li
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2019
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-019-1720-7

Other articles of this Issue 1/2019

World Journal of Surgical Oncology 1/2019 Go to the issue