Surgical resection of vulvar metastases of endometrial cancer: a presentation of two cases

OBJECTIVE: Endometrial cancer generally carries a good prognosis. However, 10% to 15% of patients will manifest recurrent disease. One half of these recurrences are confined to the vagina. Whereas pelvic recurrence is most common in patients who do not receive postoperative adjuvant radiation therapy, distant metastases predominate among patients who received postoperative radiation therapy. Surgical resection of disease may be possible, therapeutic and even curative, in select patients with isolated cancer recurrence. CASE 1: A 63-year-old patient presented 7 years after treatment of endometrial cancer with a vulvar lesion and groin mass. The lesions were successfully resected and confirmed to be recurrent endometrial cancer. Adjuvant radiation and chemotherapy were prescribed leading to a complete clinical response. This patient survived without evidence of disease for 1 year. However, she eventually died 8 months later because of a disease recurrence. CASE 2: An 83-year-old patient with a history of a hysterectomy for endometrial cancer and radiation therapy for a vaginal vault recurrence presented with an exophytic labial mass. After radical wide excision of her vulvar mass and bilateral groin dissection, final pathology revealed that the mass was consistent with recurrent endometrial cancer. This patient remains without evidence of disease 18 months after treatment of disease recurrence. CONCLUSIONS: Uncommon sites of recurrence of endometrial cancer may include the vulva. These rare metastases may be amenable to surgical resection with adjuvant therapy as indicated.