Unusual Presentation of Metastatic Cervical Squamous Cell Carcinoma with Serum Positive Beta Human Chorionic Gonadotropin.

Abstract We present a case of a 30-year-old female who presented with one month of worsening dyspnea. On admission she was having pleuritic chest pain with associated cough and worsening dyspnea. CTA showed a moderate sized pleural effusion with two hypodensities noted in the liver. Patient received several thoracenteses and had abdominal distension that required paracentesis, which showed transudative fluid initially. There was a noted supraclavicular lymph node, however the patient refused lymph node biopsy. Retroperitoneal lymph node, which was seen on CT abdomen, was eventually biopsied which showed metastatic carcinoma with squamoid differentiation with unknown primary. Beta subunit of human chorionic gonadotropin (b-HCG) was rechecked for the biopsy and was mildly elevated to 33. The patient refused gynecological evaluation, pelvic ultrasound revealed a distended endometrial cavity with heterogeneous contents and a complex left adnexal cyst. Pelvic MRI noted a large cervical mass (4.6x4.5x3.8cm) with parametrial invasion. Subsequently her status declined, and she was intubated for hypoxic respiratory failure. Patient unfortunately passed away. Autopsy confirmed metastatic cervical cancer with significant tumor burden as evidence of >80% of the liver with tumor. Although the patient’s pap smear previously did not culture for HPV, the lymph node biopsy stained positive with Pap stain and shown that the carcinoid cells were most affected by HPV. Later is was found that 3.5 years prior the patient had a Pap smear positive for low-grade squamous intraepithelial lesion however was lost to follow up. Although there have been studies that have examined cervical cancer and the intracellular expression of b-hCG, serum b-hCG is not known to be elevated in squamous cell carcinoma of the cervix. For women presenting with wide spread disease, gynecological malignancies should be ruled out regardless of age.