Unusual presentation of cervical cancer as advanced ovarian cancer

Background: Ovarian metastases from cervical cancers are uncommon. In most cases, the primary site of cervix is known before the occurrence of metastasis. We report a case of cervical adenocarcinoma presenting primarily as advanced ovarian cancer with the primary site totally silent. Case report: A 47-year old multiparous patient presented to her local hospital with vague abdominal pain for 2 months. Initial investigations with abdominal ultrasound and computerized tomography scan suggested right ovarian dermoid cyst. Her CA125 was 12 μ/ml (0-35). Right salpingo-oophorectomy was performed with the histologic diagnosis of dermoid cyst. Follow-up after 5 months showed a higher level of serum CA 125 (1,594 μ/ml) and a negative cervical smear. Exploratory laparotomy was done with the intent to progress to total abdominal hysterectomy, left salpingo-oophorectomy and omentectomy with staging. Surprisingly, the histologic features of the specimen obtained at laparotomy were consistent with a moderately differentiated cervical adenocarcinoma with metastases to corpus uterus, ovaries, left fallopian tube, omentum and pleural cavity. The final stage was stage IV cervical cancer. Following this, the patient was referred to medical oncologist for chemotherapy. Conclusion: Cervical carcinoma should be suspected in any patient presented with bilateral ovarian tumors and positive ascitic fluid cytology. Negative cervical smears do not exclude the possibility of primary cervical carcinoma.