BRAIN METASTASES FROM PRIMARY UTERINE CERVICAL CANCER: A CASE REPORT AND A LITERATURE REVIEW

Background :Brain metastasesfromprimarycervical cancer are very rare.Wepresentthis report, to describe a case of brainmetastasesfromprimaryuterine cervical cancer and to conduct a literaturereview about clinicalpresentation, treatment, and prognosis of thisdesease. Case Presentation :A 51-year-old woman, followed since 2017 for squamous cell carcinoma of the cervix for which she had underwent surgical treatment and received radiotherapy, being asymptomatic for 4 years after completion of treatment.She is brought to the Emergency Department in February 2021 forintracranial hypertension syndrome associated with behavioral troubles, symptoms that developed progressively during the last two months before her consultation.The clinical examination found a conscious patient without sensory or motor deficit and without damage to the cranial nerves. A cerebral Magnetic Resonance Imaging (MRI) revealed a left frontal tumor process 50 mm in diameter enhanced peripherally after injection of contrast product, necrotic and surrounded by significant cerebral edema determining a mass effect on the median structures with signs of engagement under falcoriel (figure 1). The patientunderwent asurgicalresectionofthetumor, themassbeingremoved en bloc. Histopathologicalandimmunohistologicalexaminationoftheresectedtumorrevealed a metastaticoriginfrom a primarycervicalsquamoscellcarcinoma. A postoperative brain scan revealed the persistence of a left frontal tumor process 14 mm in diameter with significant perilesional edema. The patient subsequently received total brain radiotherapy at a dose of 37.5 Gy (15 fractions of 2.5 Gy) then an additional dose on the tumor residue at a total dose of 10 Gy (4 fractions of 2.5 Gy). A control scan performed one month after the end of radiotherapy showed a regression in size of the lesion of the left frontal cerebral lesion and the perilesional oedema.Twelve months after the end of radiotherapy, a CT scan revealed progression of the secondary cerebral localization.Sixteen months after the end of radiotherapy, the patient was still alive and followed in oncology. Conclusion: Brain metastases from primary uterine cervical tumors are extremely rare and generally have a poor prognosis.Multimodal therapy such as surgery and radiotherapy, depending on the clinical status of individual patients,should be recommended in patients with brain metastasis to improve survival.