Patterns of Pulmonary Metastasis from Uterine Cancer

Abstract

Background: Endometrial cancer is the most common female genital cancer and approximately 90% of the cases are diagnosed while they are still confined to the uterus. However, the frequency and the pattern of pulmonary metastasis (PM) have not been studied systematically. Patients and Methods: From 1962 to 1989, 90 patients wit PM were identified by computerized search of the medical records of the 1,550 (5.8%) patients admitted to the Massachusetts General Hospital with the diagnosis of uterine cancer. The median age of the patients was 67 years (range from 42 to 88 years). The histology of the uterine neoplasms included 53 adenocarcinomas (59%), 19 sarcomas (21%), 12 adenosqamous carcinomas (13.5%), 4 adenoacanthomas (4.5%), and 2 clear cell adenocarcinomas (2%). Chest radiographs were retrospectively reviewed by two experienced readers. Results: Lung metastases were found at the time of diagnosis of the primary tumor in 20 patients (22%). The usual pattern of PM involved multiple pulmonary nodules in 65 patients (72%); solitary pulmonary nodules were found in 16 (18%), mass lesion in 10 (11%), lymphangitic spread in 3, and pleural effusion in 6 (6.7%). Cavitation and tracheal metastasis were observed in one case each. Conclusion: Pulmonary metastases represent a common site of extrapelvic spread of disease for the small number of patients with advanced or recurrent endometrial carcinoma. The usual type of PM is multiple bilateral nodules.

Thoracic manifestations of Gynecological tumors: Airway and lung parenchymal involvement commoner in endometrial and ovarian cancers while pleural and interstitial involvement is predominant in cervix malignancies

“…In a study by Bouros et al (51), only 6 of the 90 patients who had pulmonary metastasis manifested a pleural effusion. Of those patients, 50% had concurrent parenchymal disease.…”

“…Bouros et al (51) have reported that up to 34% of patients presented with pulmonary metastasis as the only site of recurrence. As seen in other malignancies, the autopsy-based rate of pulmonary metastasis is much higher documented by Turner et al (50).…”

“…Few studies have focused solely on the patterns of thoracic involvement in metastatic uterine cancer. Bouros et al (51) in their study reviewed 1550 patients who were admitted with a diagnosis of uterine cancer over a 27-year experience. The study identified 90 (5.8%) patients who had pulmonary involvement, with varying histopathology.…”

“…Older series (52) similarly reported multiple bilateral nodules as the primary pattern of thoracic metastasis. Solitary pulmonary nodules are not as common, and represent between 12% and 18% of all thoracic metastases (51,52).…”

“…Incidence of hematogenous metastasis is low in endometrial cancer. Pulmonary metastases represent a common site of extra-pelvic spread of disease but incidence is only 2.3%-4.6% (4,5).…”