Brain and scalp metastasis of cervical cancer in a patient with human immunodeficiency virus infection: A case report.

Abstract

Background: Cervical cancer is the most commonly diagnosed cancer worldwide and the most common cancer in females living with human immunodeficiency virus (HIV). Cervical cancer is classified as an acquired immune deficiency syndrome-defining disease. Brain metastases (BMs) from cervical cancer are extremely rare, with an incidence rate of approximately 0.63%, and there is limited information on optimal treatment protocols and patient outcomes. Since brain lesions are sequestered behind the blood-brain barrier, multimodal treatment approaches are crucial to help improve the prognosis of cervical cancer in patients with BMs who are also living with HIV.

Case summary: A 42-year-old Chinese female with HIV infection was diagnosed with stage IIIC1r cervical cancer in March 2022 based on the International Federation of Gynecology and Obstetrics system. Fourteen months after undergoing the initial treatment with concurrent chemotherapy and radiotherapy in January 2024, the patient presented to a local hospital with a severe explosive headache. The patient underwent craniotomy and postoperative pathological examination confirmed metastasis of cervical squamous cell carcinoma to the brain on February 1, 2024. Following surgery, the patient received external beam radiotherapy for the metastatic lesions. The patient has been under observation for 7 months with no evidence of tumor recurrence.

Conclusion: Females living with HIV are more than three times more likely to be diagnosed with cervical cancer. Due to the scarcity of cervical cancer BMs, therapeutic protocol experience is limited. In addition to the existence of the blood-brain barrier, the treatment of cervical cancer BMs appears to be exceptionally complex, and a multi-modal treatment approach consisting of chemotherapy, surgery, and radiation may help prolong patients' life. For females living with HIV, antiretroviral therapy should be prioritized, as recommended by the Center for Disease Control in China. An intact immune system and a high CD4⁺ count are positive indicators of treatment response and tumor reduction. The overall survival of patients with cervical cancer after brain metastasis is approximately 3-5 months. However, owing to multimodal therapy and the use of antiretroviral therapy, the patient reported in this case showed no signs of recurrence after prolonged follow-up.