Cavitary lung nodules: a rare manifestation of metastatic uterine cancer

SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Endometrial carcinoma is developed countries' most common gynecological cancer (1). Early presentation confers a high 5-year survival rate; however, progression to stage IV carries a significantly lower 5-year survival rate, as low as 5.7%. Initial presentation with metastatic disease is rare, and the prognosis is worse with multiple sites of metastases (2). Endometrial carcinomas may recur after initial treatment, typically involving the pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs (3,4). Endometrial carcinoma has a higher frequency of pulmonary metastasis when compared to other gynecologic malignancies, about 20-25% (4). Commonly, cavitation is seen, and lesions are usually multiple. Pleural involvement, such as effusions, nodularity, or thickening, is less common (4,5). Pulmonary metastasectomy can be performed under specific inclusion criteria and has been shown to achieve long-term survival benefits in select cases, as demonstrated by retrospective studies (3). CASE PRESENTATION: We briefly review a case of uterine cancer FIGO stage Ib which has metastasized to the lung in a 65-year-old female. The initial diagnosis was approximately 5 years prior to this presentation; at that time, she underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy. She did not receive adjuvant chemotherapy or radiation therapy. Upon re-presentation, she was experiencing pain in the abdomen and pelvis. She underwent computed tomography (CT) imaging of the abdomen and pelvis, which incidentally revealed bilateral pulmonary nodules seen in the lung bases. This was further evaluated by dedicated chest CT imaging and then followed up with positron emission tomography (PET-CT) imaging to look for additional distant metastasis. Images of the chest showed multiple stable appearing subcentimeter solid and cavitary nodules throughout all lobes, as seen in figure 1. Right sided Video-assisted thoracoscopic surgery (VATS) with upper and middle lobe wedge resection was performed. Samples were sent for histopathological analysis and demonstrated multiple tumor nodules with metastatic uterine carcinoma (endometrioid type) with positive estrogen and progesterone receptors (ER/PR+). The patient was subsequently started on hormonal therapy, and a chemo-port was placed to begin chemotherapy. DISCUSSION: This case highlights the potential manifestations of recurrent uterine cancer, notably the spread to a distant extra-pelvic site. Lung involvement can predict survival; this helps clinicians provide their patients with accurate information regarding prognosis. Treatment strategies vary for the site of metastasis (6). When Lung metastasis is found, surgical intervention has conferred increased survival rates, as mentioned above. Several treatment strategies have been employed to increase survival in cases with distant metastasis. This case demonstrates a combination of treatment strategies with the hopes of improving patient prognosis. Pulmonary metastasectomy with wedge resection, hormonal therapy due to ER/PR + seen on histological analysis, and insertion of chemo-port for adjunctive chemotherapy. CONCLUSIONS: This case presents a rare pulmonary manifestation of metastatic uterine cancer in a patient without respiratory symptoms. A multidisciplinary, evidence-based approach to treatment was employed, and the patient will continue to have routine follow-ups with medical oncology for continued therapy and disease management. REFERENCE #1: Siegel, R., Naishadham, D., & Jemal, A. (2013). Cancer statistics, 2013. CA: a cancer journal for clinicians, 63(1), 11–30. https://doi.org/10.3322/caac.21166 REFERENCE #2: Kraemer, O., Rapiti, E., Huber, D., Lopes-Raimundo, E., Usel, M., Bouchardy, C., & Petignat, P. (2015). Stage IVB endometrial cancer: clinical course and survival of patients with single and multiple metastases. European journal of gynaecological oncology, 36(5), 529–532. REFERENCE #3: Anile, M., Mantovani, S., Pecoraro, Y., Carillo, C., Gherzi, L., Pagini, A., Rendina, E. A., Venuta, F., & Diso, D. (2017). Pulmonary metastasectomy in uterine malignancies: outcome and prognostic factors. Journal of thoracic disease, 9(Suppl 12), S1273–S1277. https://doi.org/10.21037/jtd.2017.07.46;Kurra, V., Krajewski, K. M., Jagannathan, J., Giardino, A., Berlin, S., & Ramaiya, N. (2013). Typical and atypical metastatic sites of recurrent endometrial carcinoma. Cancer imaging : the official publication of the International Cancer Imaging Society, 13(1), 113–122. https://doi.org/10.1102/1470-7330.2013.0011;Bouros, D., Papadakis, K., Siafakas, N., & Fuller, A. F., Jr (1996). Patterns of pulmonary metastasis from uterine cancer. Oncology, 53(5), 360–363. https://doi.org/10.1159/000227588;Liu, Y., Chi, S., Zhou, X., Zhao, R., Xiao, C., & Wang, H. (2020). Prognostic value of distant metastatic sites in stage IV endometrial cancer: A SEER database study of 2948 women. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 149(1), 16–23. https://doi.org/10.1002/ijgo.13084 DISCLOSURES: No relevant relationships by Fahid Alghanim No relevant relationships by William Arvan