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Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 179--180

Ileocaecal Metastasis from Carcinoma Cervix presenting with bowel obstruction: A rare case report

M Choudhury, S Singh, V Puri, M Nain 
 Department of Pathology, Lady Hardinge Medical College, New Delhi, India

Correspondence Address:
V Puri
Department of Pathology, Lady Hardinge Medical College, New Delhi
India




How to cite this article:
Choudhury M, Singh S, Puri V, Nain M. Ileocaecal Metastasis from Carcinoma Cervix presenting with bowel obstruction: A rare case report.Indian J Cancer 2015;52:179-180


How to cite this URL:
Choudhury M, Singh S, Puri V, Nain M. Ileocaecal Metastasis from Carcinoma Cervix presenting with bowel obstruction: A rare case report. Indian J Cancer [serial online] 2015 [cited 2020 Jul 12 ];52:179-180
Available from: http://www.indianjcancer.com/text.asp?2015/52/2/179/175808


Full Text

Sir,

Cervical carcinoma can metastasize to lymph nodes, liver and lung via haematogenous and lymphatic route. Bowel involvement can rarely occur as a component of generalised carcinomatosis. However, isolated involvement of ileo-caecal region is very rare.

A 45 year old female presented with symptoms of colicky pain abdomen, vomiting and constipation of 10 days duration. There was a past history of squamous cell carcinoma cervix two years back. She had been treated successfully with Wertheim's hysterectomy and brachytherapy. General physical examination revealed severe dehydration and pallor. There was no lymphadenopathy. Abdominal examination showed abdominal distension with no organomegaly or free fluid in the peritoneal cavity. Abdominal radiograph confirmed large bowel obstruction. There was no evidence of liver metastasis or lymphadenopathy on ultrasonography. Per vaginal examination revealed a hard fixed growth over vaginal vault. She was subjected to laprotomy with right hemicolectomy and a portion of terminal ileum was also resected. Gross examination showed a greyish white solid growth in caecal region and stricture in the ileum with thickening of its wall [Figure 1]. There was no evidence of peritoneal seeding. Microscopically, there was evidence of squamous cell carcinoma invading caecal wall as well as into the ileal stricture. Tumour extended from the serosa upto the mucosa; however mucosal surface was normal in the multiple sections studied from the caecal and ileal walls [Figure 2]. Sections from appendix, omentum, lymph nodes and mesentry were free of tumour. Biopsy of vaginal vault showed a well differentiated squamous cell carcinoma. Based on clinico-pathological examination, a final diagnosis of metastatic well differentiated squamous cell carcinoma, caecum, ileum and vaginal vault was made. Patient died within 10 days post surgery. Metastasis of carcinoma cervix to the ileum or caecum or both is extremely rare with only a few reports in literature reveal isolated involvement of bowel.[1],[2],[3]{Figure 1}{Figure 2}

The route of metastasis to bowel is either via retrograde lymphatic spread or via direct extension because of its close relationship with pelvic wall. In our patient there was no evidence of lymph node involvement. Treatment is essentially in the form of either a palliative intestinal resection or a bypass surgery to relieve intestinal obstruction as done in present case. The prognosis of these patients is extremely poor.

References

1Mathur SK, Pandya GP. Solitary metastatic malignant stricture of the ileum: A rare cause of small bowel obstruction (a case report). J Postgrad Med 1984;30:186-8.
2Marjmin O, Badrulhisham B, Teoh CM, Sukumar N, Ahmad Zakuan K. Metastatic Cervical Carcinoma in the Caecum. Med J Malaysia 2005;60:97-8.
3Sudirman A, Sukumar N, Davaraj B. Appendicular metastasis from carcinoma cervix. Med J Malaysia 2001;56:100-1.