Vulvar cancer: brain metastases. Clinical observation

Abstract

Introduction. Brain metastases can occur in almost all gynecological malignancies and, despite modern therapeutic options, have a poor prognosis. Brain metastases from vulvar cancer are considered to be rare. In the literature, the reports on these cases have identity character.
 The aim is to show clinical observation of the patient with vulvar cancer with brain metastases.
 Results. Patient S., 60 years old, with stage I р T1N0M0 vulvar cancer underwent vulvectomy in January 2018. During the histological study in the subepithelial layers were the areas of kraurosis with the growth of squamous cell keratinous carcinoma. Taking into account the prevalence of the tumor process, adjuvant treatment was not carried out. Two years later, in January 2020, there were focal symptoms in form of weakness in the left upper and lower limbs, an unsteady gait, a generalized weakness. During magnetic resonance imaging (MRI) of the brain in the occipital lobe paraventricular with intensive perifocal edema to the right was determined cystic-solid formation with rough edges which size was 293365 mm without clinically significant mass-effect. The middle structures were not displaced. Positron emission tomography-computed tomography (PET/CT) was performed to detect the prevalence of the tumor process. Data on the presence of the active specific process at the time of study were not received. Taking into account the absence of other indicators of generalization process, whole brain radiation therapy (single fraction dose of 3 Gy, total radiation dose of 30 Gy) was carried out, followed by the application of Temodal. The patient was examined in 6 months. There were no signs of progression.
 Conclusion. Brain metastases from vulvar cancer are considered to be rare. This clinical case is interesting because brain metastases have been the only manifestation of the progression of the tumor process in the absence of regional lymph nodes damage. The main diagnostic method is MRI of the brain. The use of PET/CT helps to detect the prevalence of the tumor process. The metastases have been detected after 36 months from the date of the initial diagnosis of the cancer. Radiation therapy is a method of choice of brain metastases treatment.