Patterns of pulmonary metastasis from uterine cancer

Background: Endometrial cancer is the most common female genital cancer and approximately 90% of the cases are diagnosed while they are still confined to the uterus. However, the frequency and the pattern of pulmonary metastasis (PM) have not been studied systematically. Patients and Methods: From 1962 to 1989, 90 patients wit PM were identified by computerized search of the medical records of the 1,550 (5.8%) patients admitted to the Massachusetts General Hospital with the diagnosis of uterine cancer. The median age of the patients was 67 years (range from 42 to 88 years). The histology of the uterine neoplasms included 53 adenocarcinomas (59%), 19 sarcomas (21%), 12 adenosqamous carcinomas (13.5%), 4 adenoacanthomas (4.5%), and 2 clear cell adenocarcinomas (2%). Chest radiographs were retrospectively reviewed by two experienced readers. Results: Lung metastases were found at the time of diagnosis of the primary tumor in 20 patients (22%). The usual pattern of PM involved multiple pulmonary nodules in 65 patients (72%); solitary pulmonary nodules were found in 16 (18%), mass lesion in 10 (11%), lymphangitic spread in 3, and pleural effusion in 6 (6.7%). Cavitation and tracheal metastasis were observed in one case each. Conclusion: Pulmonary metastases represent a common site of extrapelvic spread of disease for the small number of patients with advanced or recurrent endometrial carcinoma. The usual type of PM is multiple bilateral nodules.