Would extirpative pelvic surgery improve survival in gynecological metastases of lung cancer? Case report and review of
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CASE REPORT
Would extirpative pelvic surgery improve survival in gynecological metastases of lung cancer? Case report and review of the literature Lusine Sevinyan4 · Marianne Illsley1 · Ben Haagsma2 · Simon Butler‑Manuel4 · Patricia Ellis4 · Thumuluru Kavitha Madhuri3,4 Received: 17 April 2020 / Accepted: 11 August 2020 © The Japan Society of Clinical Oncology 2020
Abstract Lung cancer is the 3rd most common cancer in the UK and the numbers of new cases increase every year. In contrast to gastrointestinal tumours and breast cancer, lung cancer, metastases to the female genital tract are incredibly rare with only five cases reported with uterine metastases on review of the published English literature. We report an interesting case of successful ongoing management of metastatic lung cancer to the pelvis along with an extensive literature review. A 47-yearold lady with recurrent respiratory tract symptoms and chest pain was diagnosed with advanced stage non-small-cell lung cancer (Stage T4N2M1A). Five years following diagnosis and several cycles of chemotherapy and radiotherapy, aged 52, she complained of post-menopausal bleeding and pelvic discomfort. An endometrial biopsy confirmed a malignancy morphologically and immunohistochemically similar to her lung adenocarcinoma, in keeping with metastatic disease. She underwent robotic surgery to excise the pelvic organs and successfully gain local disease control. The patient remains clinically stable 3 years following hysterectomy. Although metastases of lung cancer to uterus are very rare, any patient with abnormal uterine bleeding with known cancer should be investigated thoroughly to rule out metastatic disease. Combined multimodal treatment as in this case may increase overall survival.
Background * Thumuluru Kavitha Madhuri [email protected] Lusine Sevinyan [email protected] Marianne Illsley [email protected] Ben Haagsma [email protected] Simon Butler‑Manuel [email protected] Patricia Ellis [email protected] 1
Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford GU2 7XX, UK
2
Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, UK
3
School of Pharmacy & Biomolecular Sciences, University of Brighton, Brighton, UK
4
Department of Gynae‑Oncology, LEVEL B GOPD, Royal Surrey NHS Foundation Trust, Egerton Rd, Guildford GU2 7XX, UK
The incidence of lung cancer is 1.82 million (1.24 million in men and 0.58 million in women) [1] worldwide and in the UK there are 46,403 new cases diagnosed each year with ever increasing numbers [2]. However genitourinary metastases from primary lung cancer are still extremely rare, particularly where the disease spreads simultaneously to multiple sites in the pelvis, including the uterus and adnexae. To our knowledge only five cases of metastatic uterine cancer from a primary lung adenocarcinoma have been reported in the english literature [3–6]. However, of these, only one had involvement of both adnexa and corpus uteri [3]. Here we report a highly unusual case
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