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Year : 2020  |  Volume : 35  |  Issue : 1  |  Page : 68-69  

Rare presentation of isolated scar site recurrence in a case of carcinoma cervix


1 Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
2 Department of Surgical Oncology, Tata Main Hospital, Jamshedpur, Jharkhand, India

Date of Submission25-Sep-2019
Date of Acceptance21-Oct-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Dr. Girish Kumar Parida
Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur - 831 001, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_176_19

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   Abstract 


Scar site recurrence is a rare phenomenon and is even rarer in squamous cell carcinoma. We present a special case of isolated scar site recurrence in a patient with carcinoma cervix detected on fluorodeoxyglucose positron emission tomography-computed tomography, 2 years after hysterectomy and radiotherapy.

Keywords: Carcinoma cervix, fluorodeoxyglucose positron emission tomography-computed tomography, scar site metastases


How to cite this article:
Parida GK, Mitra S, Jena S, Suman A, Muthu GS. Rare presentation of isolated scar site recurrence in a case of carcinoma cervix. Indian J Nucl Med 2020;35:68-9

How to cite this URL:
Parida GK, Mitra S, Jena S, Suman A, Muthu GS. Rare presentation of isolated scar site recurrence in a case of carcinoma cervix. Indian J Nucl Med [serial online] 2020 [cited 2020 Feb 24];35:68-9. Available from: http://www.ijnm.in/text.asp?2020/35/1/68/274371



A 55-year-old woman, with a history of squamous cell carcinoma cervix, for which she underwent hysterectomy followed by local radiotherapy 2 years back, now presented with pain abdomen for the last 2 months. On clinical examination, there was a hard, fixed mass palpable in the lower anterior abdominal wall. With the suspicion of recurrence, she was referred to our department for fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT). FDG PET-CT showed metabolically active heterogeneous density lobular lesion in the lower anterior abdominal wall involving bilateral rectus abdominis muscles, along the hysterectomy scar as seen in MIP [Figure 1]a, CT [Figure 1]b, [Figure 1]C, [Figure 1]d, and fused PET-CT images [Figure 1]e, [Figure 1]F, [Figure 1]g, suggesting scar site metastases. No other hypermetabolic lesion in the rest of the body was noted. This lesion was later confirmed on histopathological examination.
Figure 1: Fluorodeoxyglucose positron emission tomography-computed tomography images show metabolically active heterogeneous density lobular lesion in the lower anterior abdominal wall involving bilateral rectus abdominis muscles, along the hysterectomy scar as seen in the MIP (a), computed tomography (b-d), and fused positron emission tomography-computed tomography images (e-g)

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The mechanism of scar site metastases has not been clear. Few authors have suggested tumor implantation at the time of surgery as a mechanism for incision site metastasis,[1] while others have suggested the mode of retrograde spread of tumor secondary to the lymphatic obstruction.[2] Scar site recurrences have been known to occur in laparotomy scar, cesarean delivery scar, episiotomy scar, etc. The selection criteria for scar site recurrence include recurrences in or near the scar, which is visible or palpable, and are histologically confirmed.[3] Metastatic scar site recurrences have been documented in adenocarcinoma of ovary, colon, gallbladder, and pancreas; however, such a phenomenon is rare in cervical carcinoma and even rarer in squamous type.[4],[5],[6],[7] Our case is an unusual one as scar site was the only site of recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Malfetano JH. Skin metastases from cervical cancer: A fatal event. Gynecol Oncol 1986;24:177-82.  Back to cited text no. 1
    
2.
Imachi M, Tsukamoto N, Kinoshita S, Nakano H. Skin metastasis from carcinoma of the uterine cervix. Gynecol Oncol 1993;48:349-54.  Back to cited text no. 2
    
3.
van den Tillaart SA, Schoneveld A, Peters IT, Trimbos JB, Van Hylckama Vlieg A, Fleuren GJ, et al. Abdominal scar recurrences of cervical cancer: Incidence and characteristics: A case-control study. Int J Gynecol Cancer 2010;20:1031-40.  Back to cited text no. 3
    
4.
Iavazzo C, Madhuri K, Tailor A, Butler-Manuel S. Incisional site metastasis in a patient with cervical carcinoma: A case report and review of the literature. Case Rep Obstet Gynecol 2012;2012:593732.  Back to cited text no. 4
    
5.
Wahlqvist L. Resection of the abdominal wall in metastasis from cancer of the bladder, kidney or colon. Eur Urol 1977;3:26-8.  Back to cited text no. 5
    
6.
Selo-Ojeme DO, Bhide M, Aggarwal VP. Skin incision recurrence of adenocarcinoma of the cervix five years after radical surgery for stage 1A disease. Int J Clin Pract 1998;52:519.  Back to cited text no. 6
    
7.
Naumann RW, Spencer S. An umbilical metastasis after laparoscopy for squamous cell carcinoma of the cervix. Gynecol Oncol 1997;64:507-9.  Back to cited text no. 7
    


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