Adenoid cystic carcinoma of the uterine cervix with metastasis 10 years postsurgery: Case report and literature review.

Adenoid cystic carcinoma (ACC) of the uterine cervix is a rare primary malignancy. A 60-year-old woman presented with a >1 year history of intermittent upper abdominal pain and discomfort, which had worsened over the preceding 4 days. Ten years earlier, the patient presented with irregular vaginal bleeding. Pelvic ultrasonography revealed a homogeneous myometrium, a clearly defined endometrium, and an indistinct echo pattern in the endocervical canal; no significant abnormalities were detected in either adnexa. Endometrial curettage and pathological biopsy confirmed ACC of the uterine cervix. The patient subsequently underwent total hysterectomy with bilateral oophorectomy, but declined postoperative adjuvant chemotherapy or radiotherapy. During the current admission, contrast-enhanced computed tomography of the entire abdomen revealed multiple, round, and slightly hypodense lesions in the right hepatic lobe, most of which were located near the liver margin and exhibited mild peripheral enhancement. Multiple soft tissue nodules of varying size were noted in the peritoneum and greater omentum, exhibiting heterogeneous and marked enhancement. Contrast-enhanced computed tomography of the head, neck, and chest revealed no significant abnormalities. Finally, fine-needle aspiration biopsy of the peritoneal nodule was performed, and metastasis of ACC of the uterine cervix was diagnosed. Palliative treatment was initiated; however, the patient died of multiple organ failure 1 month after treatment. This case indicates that ACC of the uterine cervix may develop distant metastasis as late as 10 years after initial diagnosis without adjuvant radiotherapy or chemotherapy. Clinicians should raise awareness of this disease, strengthen long-term follow-up, and perform timely imaging evaluations when symptoms occur.