Metastatic bone involvement in vulvar cancer: report of a rare case and review of the literature

Purpose: Bone metastasis secondary to vulvar carcinoma is an infrequent clinical entity. Only ten cases have been published in the literature. We describe a case of squamous vulvar carcinoma, that presented with cervical vertebral involvement, as a part of distant spread. Case: A 69-year-old woman presented with radicular pain and a painful cervical mass. MRI of the cervical spine was performed, showing an osteolytic lesion with spinal cord compression. Conclusion: This case was unique in presenting vertebral metastasis eight months after chemotherapy and radiotherapy.

Vulvar cancer; Bone metastasis; Radiotherapy

[1] Deutsche Krebsgesellschaft (DKG) Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. Diagnostik und Therapie des Vulvakarzinoms und seiner Vorstufen, AWMF 032/032 (S2k) statements. 2008, http://www.dggg.de.

[2] Schnürch H.G., Hantschmann P.: “Vulvar cancer: diagnosis and treatment”. Der Gynäkologe, 2008, 41, 215.

[3] Hampl M., Deckers-Figiel S., Hampl J.A., Rein D., Bender H.G.: “New aspects of vulvar cancer: changes in localization and age of onset”. Gynecol. Oncol., 2008, 109, 340.

[4] Akerman G., Dussour C., Haddad B., Paniel B.-J., Rouzier R.: “Epidemiology of vulvar intra-epithelial neoplasias”. Gynecol. Obstet. Fertil., 2007, 35, 1251.

[5] Cancer Research U.K. UK vulva cancer incidence statistics. 2008, http://info.cancerresearchuk.org/cancerstats/types/vulva/incidence

[6] Fischer F., Kuhl M., Feek U., Rominger M., Schipper M.L., Hadji et al.: “Bone metastases in vulvar cancer: a rare metastatic pattern”. Int. J. Gynecol. Cancer, 2005, 15, 1173.

[7] Ghaemmaghami F., Modares M., Behtash N., Moosavi A.Z.: “Multiple, disseminated cutaneous metastases of vulvar squamous cell carcinoma”. Int. J. Gynecol. Cancer, 2004, 14, 384.

[8] Tjalma W.A., Watty K.: “Skin metastases from vulvar cancer: a fatal event”. Gynecol. Oncol., 2003, 89, 185.

[9] Buxant E., Anaf V., Haouari H.: “Rapid groin recurrence of a vulvar carcinoma with invasion of the femoral vessels and the importance of the initial groin dissection in the staging surgery”. Gynecol. Oncol., 1993, 48, 189.

[10] Baize N., Mahamat A., Benizri E., Saint-Paul M.C., Mounier N.: “Bone metastasis from endometrioid ovarian carcinoma: a case study and literature review”. Eur. J. Gynaecol. Oncol., 2009, 30, 326.

[11] Kaya A., Olmezoglu A., Eren C.S., Bayol U., Altay T., Karapinar L. et al.: “Solitary bone metastasis in the tibia as a presenting sign of endometrial adenocarcinoma: a case report and the review of the literature”. Clin. Exp. Metastasis., 2007, 24, 87.

[12] Mohanty A., Dutta D., Das S., Samanta D., Senapati S.: “Skull metastasis from carcinoma of the cervix: a rare case and review of the literature”. J. Obstet. Gynaecol Res., 2010, 36, 441.

[13] Noronha V., Cooper D.L., Higgins S.A., Murren J.R., Kluger H.M.: “Metastatic myoepithelial carcinoma of the vulva treated with carboplatin and paclitaxel”. Lancet Oncol., 2006, 7, 270.

[14] Eifel P.: “The vulva and vagina”. In: Cox J.D., Ang K.K. (eds.). Radiation Oncology: Rationale, Technique, Results. 8th ed. St. Louis, Mosby, 2003, 743.

[15] Seltzer V.L., Beckman M.: “Pathologic fracture of the ulna secondary to metastatic vulvar carcinoma: Report of a case”. Gynecol. Oncol., 1976, 4, 232.

[16] Brufman G., Krasnokuki D., Biran S.: “Metastatic bone involvement in gynecological malignancies”. Radiologica Clin., 1978, 47, 456.

[17] Sharma S.K., Isaaks J.H.: “Bone metastasis in vulvar carcinoma”. Gynecol. Oncol., 1985, 20, 156.

[18] Abdul-Karim F.W., Kida M., Wentz Budd W., Carter J.R., Sorensen K., MacFee M. et al.: “Bone metastasis from Gynecologic Carcinomas: a clinicopathologic study”. Gynecol. Oncol., 1990, 39, 108.

[19] Prewett S., Venkitaraman R.: “Metastatic spinal cord compression: review of the evidence for a radiotherapy dose fractionation schedule”. Clin. Oncol. (R. Coll. Radiol.), 2010, 22, 222.

[20] Sun H., Nemecek A.N.: “Optimal management of malignant epidural spinal cord compression”. Emerg. Med. Clin. North Am., 2009, 27, 195.