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
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 1a], CT [Figure 1b-d], and fused PET-CT images [Figure 1e-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)
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.
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