SUPRACLAVICULAR AND CERVICAL LYMPH NODE METASTASES HAVING CERVICAL CANCER AS STARTING POINT. CASE PRESENTATION

Abstract

Introduction: Cervical cancer is the fourth most frequently found cancer among women worldwide. Numerous studies have underlined that persistent infection with human papilloma virus is the most important risk factor, two strains of the same virus – 16 and 18 being responsible for approximately 70% of the cases. Cervical cancer rarely metastasizes in the cervical lymph nodes and this indicates a poor prognosis. Literature data reports an incidence for left supraclavicular M1LYm of 0.1-1.5%. Material and Method: We bring attention to the case of a 44-year-old patient from the rural area who was diagnosed in January 2019 with stage IIIB cervical cancer, represented morphologically by a poorly differentiated squamous cell carcinoma. When admitted, the patient presented clinically with vaginal hemorrhage, intense abdominal and pelvic pain, fatigue, a dynamic, significant weight loss. The physiological personal history revealed nine pregnancies, the first one when she was 16. After pretherapeutic evaluation, the multidisciplinary committee decides performing simultaneous radio-chemotherapy with platinum salts. During the second week of treatment clinical examination revealed left cervical and supraclavicular adenopathy, both documented through imaging evaluation. Lymph node biopsy is done and its histopathological aspect, correlated with the immunohistochemistry profile supports the diagnosis of poorly differentiated squamous cell carcinoma lymph node metastasis. The initial treatment scheme is maintained, the patient being discharged with clinical remission of cervical and supraclavicular lymph node metastasis. Conclusions: The peculiarity of the case is determined by the distant metastases in the left cervical and supraclavicular lymph nodes, a rare finding during treatment, which was associated with a poor prognosis; in this case treatment was done for palliative purposes. Rapid diagnosis is the main factor that conditions the therapeutic results and chances for healing.