P1.03-031 Gynecological Malignancies and Imaging Patterns. An Interesting Case Report and Literature Surveillance

Abstract

Gynecologic malignancies are a heterogeneous group of common neoplasms in women. Thoracic abnormal findings exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. It is not rare, thoracic involvement occurring years post first diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from gynecologic carcinomas typically manifest as pulmonary nodules and lymphadenopathy. Ovarian cancer often presents small pleural effusions and subtle pleural nodules whereas metastatic lung lesions, lymph nodes, and pleura are thought to present calcification or mimicking granulomatous disease. Metastases from fallopian tube carcinomas have imaging features identical to ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, the cavitary metastatic lesions occur more often. Metastatic choriocarcinoma to lung characteristically exhibits solid pulmonary nodules. There are also reported pulmonary metastases from gynecologic malignancies with characteristic features such as cavitation (as awaited in squamous cell cervical cancer) and the “halo” sign (in hemorrhagic metastatic choriocarcinoma lesions) at computed tomography. We report a case with a mass in left paratracheal area invading the lung hinting primary lung cancer. The female patient, 36 years old with previous medical history of resected cervical cancer, underwent endoscopy with aim to have transbronchial aspiration but unfortunately the samples taken were consistent of inflammation infiltration. Thus she underwent thoracotomy due to high SUV (12) uptake points at PET CT with intention to exclude lung cancer. She had the mass removed with all the surrounding lung parenchyma but unfortunately the final histologic report documented metastatic infiltration from cervical cancer in competence with her previous medical history 6 years ago (Ib stage with radiotherapy only treated in adjuvant basis). She recovered well and was initiated chemotherapy for the gynecological malignancy stated She is now 2 years later alive, with no residual disease The basic is that malignancies are always suspected to be primary originated but the medical previous history should not be ignored, even the imaging tests tend to resemble to other entities. Therefore, radiologists should consider the presence of locoregional disease in combination with elevated tumor marker levels when interpreting imaging studies and all previous medical history of the patient’s malignancy to exclude metastatic disease.