Thoracic manifestations of Gynecological tumors: Airway and lung parenchymal involvement commoner in endometrial and ovarian cancers while pleural and interstitial involvement is predominant in cervix malignancies

Introduction:The thorax is a frequent site of metastasis from numerous non-pulmonary cancers. Intrathoracic metastatic disease may manifest in a variety of forms, including solitary or multiple pulmonary nodules, endobronchial tumor, lymphangitic carcinomatosis, or a pleural effusion.Material and Methods:This is muticentric, observational study conducted in Pulmonary Medicine, MIMSR medical college & Venkatesh chest hospital and critical care center, Latur during June 2012 to November 2016 to observe various thoracic manifestations of gynecological malignancies. Total 2300 cases of various gynecological malignancies were screened and finally 330 cases showing various thoracic manifestations were enrolled after subjecting those cases to inclusion and exclusion criteria. All study cases were subjected to chest radiological investigations and histopathological investigations whenever necessary to diagnose metastatic disease. Hospital’s ethical committee & IRB approval has been taken and written informed consent of patient was taken before enrollment.Results:Screened total 2000 cases of gynecological malignancies (ovary, endometrium, cervix & benign ovarian tumors) and selected 330 cases with various metastatic thoracic manifestations. Malignant gynecological tumors including endometrial, cervical & ovarian cancers predominantly observed in above 50 years of age while benign ovarian and uterine tumors in below 50 years of age (p<0.00001). In study of 100 cases of ovarian cancer with thoracic manifestation, documented lung mass lesion as predominant involvement in 38% cases, pleural effusion in 19% cases & lymphangitic carcinomatosis in 11 % cases. In study of 100 cases of endometrial cancer with thoracic manifestation, documented lung mass lesion as predominant in 58% cases, endobronchial metastasis in 16% cases & lymphangitic carcinomatosis in 6 % cases. In study of 100 cases of cervical cancer with thoracic manifestation, documented lymphangitic carcinomatosis as predominant in 36 % cases, pleural effusion in 26% cases & endobronchial metastasis in 5 % cases. Lung metastasis and endobronchial involvement documented predominantly in ovarian and endometrial malignancies while pleural effusion and lymphangitic carcinomatosis documented predominantly in cervical malignancies (p<0.00001). Involvement of airway (endobronchial metastasis) and lung parenchymal mass lesion predominantly documented in endometrial malignancies; lung parenchymal (mass lesion) with lymphangitic carcinomatosis in ovarian malignancies and predominantly pleural involvement with lymphangitic carcinomatosis documented in cervical malignancies (p<0.003).Conclusions:Thoracic metastatic manifestations of gynecological tumors are underdiagnosed & less reported in clinical practice because of lack of suspicion & use of modern radiological techniques to diagnose these lesions. Cases with gynecological tumors with respiratory symptoms should be evaluated with all possible conventional & advanced diagnostic methods to document metastatic manifestations of these tumors to have successful treatment outcome and longevity in survival.