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LETTER TO EDITOR
Year : 2013  |  Volume : 50  |  Issue : 1  |  Page : 45
 

Lymph node metastases in carcinoma of cervix


Department of Radiotherapy, M.L.N. Medical College, Allahabad, Uttar Pradesh, India

Date of Web Publication20-May-2013

Correspondence Address:
R Kesarwani
Department of Radiotherapy, M.L.N. Medical College, Allahabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.112320

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How to cite this article:
Kesarwani R. Lymph node metastases in carcinoma of cervix. Indian J Cancer 2013;50:45

How to cite this URL:
Kesarwani R. Lymph node metastases in carcinoma of cervix. Indian J Cancer [serial online] 2013 [cited 2020 Jun 5];50:45. Available from: http://www.indianjcancer.com/text.asp?2013/50/1/45/112320


Sir,

The isolated recurrences with absence of disease in the pelvis are rare in carcinoma uterine cervix and if seen, are confined to the para-aortic lymph nodes. Isolated recurrence in the mediastinal lymph nodes is extremely rare. Common primary sites, which give rise to mediastinal lymph nodes metastases, are lung or infradiaphragmatic organs such as gastroesophageal, pancreatic, and testicular tumor. [1] I hereby present a case of 48 years of female, known case of carcinoma cervix, treated 5 year back, presented with metastases in mediastinal lymph nodes.

A 48-year-old female attended the clinic with history of dry cough and breathlessness for 3-months' duration. There was no history of blood during cough. There was no history of bloody or watery discharge through per vaginum. Her pelvic examination and general physical examination was unremarkable. She was a known case of carcinoma cervix stage IIB, and histological diagnosis was keratinizing squamous cell carcinoma. She had received radiotherapy (external beam radiotherapy and brachytherapy) to the pelvis for the same illness 5 years back. Three years after completion of her radiation treatment, she developed the lung metastases, for which she received injection cisplatin and 5-fluorouracil for 6 cycles in other institute. She got the complete radiological response after chemotherapy. Her lung metastases were not biopsied.

When she presented to me, she underwent chest radiography, which was suggestive of mediastinal widening. Computed tomography scan (CT scan) of chest was performed, which showed soft tissue mass lesion of 46 × 38 mm in size encasing narrowing right branch of pulmonary artery and superior venacava with dilated azygous vein [Figure 1].
Figure 1: CT scan of chest showing mediastinal mass

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In view of no loco-regional recurrence and no other visible distant metastases other than mediastinum, she planned for external beam radiation therapy to mediastinum (50.4 Gy/28 fractions/5.5 weeks) with reducing field in conjunction with concurrent chemotherapy with weekly cisplatin (dose-40 mg/m 2 ). Repeat CT scan after 4 months of completion of treatment showed no evidence of disease other than parenchymal fibrosis, which appears as radiation pneumonitis, later improves with corticosteroids [Figure 2]. During her follow-up of 16 months, she was asymptomatic, and her chest radiograph was performed at 1 year, which showed evidence of fibrosis but no soft tissue mass. At 16 months of her follow-up, her chest CT scan was performed, which does not show any soft tissue mass.
Figure 2: CT scan of chest post-chemoradiation

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Thoracic metastases in carcinoma uterine cervix are more common with adenocarcinoma in comparison to squamous cell carcinoma. [2] Patients of squamous cell carcinoma of uterine cervix who presented with thoracic metastases, pulmonary nodules are more common presentation in comparison to mediastinal or hilar lymph nodes. [3]


  Conclusion Top


Any mediastinal mass present in old case of carcinoma cervix can be treated with chemotherapy and radiotherapy. In present case, we have seen complete response, which is maintaining till last follow-up of 16 months.

 
  References Top

1.Cameron RB, Loehrer PJ, Thomas Cr Jr. Neoplasms of the Mediastinum. In: Devita VT Jr, Lawrence TS, Rosenberg SA, editors. Principles and Practice of Oncology. 8 th ed. Philadelphia: Wolters Kluwer/Lippincott Willams and Wilkins; 2008. p. 973.  Back to cited text no. 1
    
2.Sostman HD, Matthay RA. Thoracic metastases from cervical carcinoma: Current status. Invest Radiol 1980;15:113-9.  Back to cited text no. 2
    
3.Shin MS, Shingleton HM, Partridge EE, Nicolson VM, Ho KJ. Squamous cell carcinoma of the uterine cervix. Patterns of thoracic metastases. Invest Radiol 1995;30:724-9.  Back to cited text no. 3
    


    Figures

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