Ovarian metastasis from squamous cell carcinoma of cervix in a patient on antiretroviral therapy: a case report.

Introduction and importance: Ovarian metastasis (OM) especially the one which is due to squamous cell carcinoma (SCC) of cervix is extremely rare and, is associated with advanced stage of cervical cancer (CC). This report highlights the importance of meticulous search for ovarian metastases. Case presentation: A 62-year old female HIV positive on antiretroviral therapy (ART) for 10 years, was presenting with history of lower abdominal pain and some distention for over six months. On examination, she was stable with moderate abdominal distension, palpable soft mass around the hypogastrium, and mild tenderness. Digital rectal examination showed a smooth rectal mucosa mass which was felt in the posterior pouch of Douglas and was not fixed to the pelvic side wall. Abdominal ultrasound showed a huge ill-defined heterogenous hypoechoic solid cervical mass of 6.5 cm in diameter. Exploratory laparotomy was done and found a left ovarian multicystic and loculated mass with an intact capsule. Histology showed well differentiated SCC of the cervix that extends to the endometrium with involvement of the parametrium, omentum, and left ovary. Ascitic fluid was also positive for malignancy. The patient was counseled and managed with palliative chemotherapy which consisted of intravenous cisplatin, magnesium sulfate, and paclitaxel. Clinical discussion: OM from cervix especially SCC are extremely rare and require meticulous investigation to differentiate from primary malignancy to the ovaries. This would help to determine proper treatment for the patients, based on the fact that the two disease entities carry different prognosis. Conclusion: OM from of CC particularly SCC is extremely rare and usually is detected incidentally during operation. Therefore, meticulous search for its presence when performing laparotomy for patients with CC may help to increase its detectability.