Bony Calvarium as the Sole Site of Metastases in Squamous Cell Carcinoma of the Uterine Cervix

Corresponding Author: Mohammad Mohammadianpanah, MD Cancer Research Center, Department of Radiation Oncology, Namazi Hospital, 71936 13311 Shiraz, Iran, Tel/Fax: +98-711-647 4320 Email: [email protected], [email protected] Introduction Squamous cell carcinoma of the uterine cervix is a major world health problem for women1. It is highly prevalent in developing countries, where the vast majority of cases occur. Cervical cancer is the sixtheen leading cause of death from cancer in women and the third leading cause of death from gynecological cancer in Iran. Age-standardised incidence rate of cervical cancer have increased slightly from 394 to 469 per 100 000 population in Iran during 2003-2006.2 Lymphatic or hematogenous spread occurs depending on the tumor stage, but dissemination does not always follow an orderly sequence and occasionally a small carcinoma may be seen infiltrating the pelvic lymph nodes or producing distant metastasis.3 The most frequent sites of distant metastases are the lungs, extrapelvic nodes and liver. Bone metastasis in cervical cancer is uncommon and mostly involves Abstract Isolated skeletal metastasis to the bony calvarium is extremely rare in patients with squamous cell carcinoma of the uterine cervix. We describe the clinical and imaging findings in a case of squamous cell carcinoma of the uterine cervix with metastases to the bony calvarium as the sole site of metastasis. The patient was a 65-year-old woman with squamous cell carcinoma of the uterine cervix, FIGO stage IIIb, whose initial treatement was chemoradiation therapy. After 22 sessions of external-beam radiation, she developed headaches. On physical examination she had skull bone tenderness. On plain skull X-ray, there were osteolytic bony lesions. Brain MRI showed multiple enhancing skull bone metatstses. Eventually, a whole body bone scintigraphy revealed isolated diffuse increased activity in the bony calvarium. In the literature review, we found only three similar cases of cervical cancer with scalp metastases and involvement of the bony calvarium.