Unit of Obstetrics and Gynecology.
Unit of Surgical Gynecol Oncology.
Medicine (Baltimore). 2021 Jun 4;100(22):e25863. doi: 10.1097/MD.0000000000025863.
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries. It is usually diagnosed at early-stage and presents a favorable prognosis. Conversely, advanced or recurrent disease shows poor outcome. Most recurrences occur within 2 years postoperatively, typically in pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs. Vulvar metastasis (VM) is indeed anecdotal probably because of the different regional lymphatic drainage from corpus uteri.
A 3 cm, reddish, bleeding lesion of the posterior commissura/right labia was found in a 74-year-old woman treated with radical hysterectomy, surgical staging, and adjuvant radiotherapy 1 year before for a grade 2 endometrioid type, International Federation of Gynecology and Obstetrics Stage IB. Vulvar biopsy confirmed the EC recurrence. Pelvic magnetic resonance imaging and positron emission tomography excluded other metastases so VM was radically resected.
Postoperative histopathology confirmed the diagnosis of grade 2 EC VM.
A radical excision of VM was performed.
Patient died from a severe sepsis 27 months after first surgery.
Vulvar metastases can show different appearance, occurring as single or diffuse lesions on healthy or injured skin. The surgical approach seems not to influence the metastatic risk, but tumor seeding and vaginal injuries should be avoided. Whether isolated or associated with recurrence in other locations, vulvar metastases imply poor prognosis despite radical treatment. Therefore, any suspected vulvar lesion arisen during EC follow-up should be biopsied and monitored closely, despite that the vulva represents an unusual metastatic site.
子宫内膜癌（EC）是发达国家最常见的妇科恶性肿瘤。通常在早期诊断，预后良好。相反，晚期或复发性疾病预后较差。大多数复发发生在术后 2 年内，通常在盆腔和主动脉旁淋巴结、阴道、腹膜和肺部。外阴转移（VM）确实是偶发的，可能是因为子宫体的区域淋巴引流不同。
一名 74 岁女性，1 年前因 2 级子宫内膜样型国际妇产科联合会（FIGO）IB 期行根治性子宫切除术、手术分期和辅助放疗治疗，术后 1 年发现后联合/右侧小阴唇有 3cm 红色、出血性病变，外阴活检证实为 EC 复发。盆腔磁共振成像和正电子发射断层扫描排除了其他转移灶，因此 VM 行根治性切除术。
术后组织病理学证实为 2 级 EC VM。
VM 行根治性切除术。
患者在首次手术后 27 个月死于严重败血症。
外阴转移可表现为不同的外观，出现在健康或受损皮肤上的单个或弥漫性病变。手术方法似乎不会影响转移风险，但应避免肿瘤播散和阴道损伤。无论孤立性或与其他部位复发相关，外阴转移均提示预后不良，尽管行根治性治疗。因此，在 EC 随访过程中出现任何疑似外阴病变均应进行活检并密切监测，尽管外阴是一个不常见的转移部位。
