“Silent” HPV-associated cervical cancer – isolated cerebellar metastasis as unusual sign of cervical adenocarcinoma: a case report and literature review

ABSTRACT
Background. This report focuses on an unusual case of primary central nervous system metastasis (CNS) from gynecological cancer, specifically endocervical carcinoma, which typically occurs as part of a disseminated disease. Brain metastases from cervical cancer are rare, occurring in only 2% of cases. We reported data from hospital registry and the available literature with using the PRISMA methodology.
Case presentation. The patient, a 48-year-old woman without relevant medical history or gynecological symptoms, went to the Emergency Room with progressive neurological symptoms. Imaging revealed obstructive hydrocephalus due to a mass in the IV ventricle, later identified as a cerebellar metastasis. Despite negative routine cervical screening, subsequent examinations revealed advanced cervical cancer with aggressive histology. The patient’s poor performance status precluded standard treatments, so she underwent palliative care. Unfortunately, she succumbed to the disease after eight months.
Conclusions. This case underscores the ability of certain cancers, like HPV-associated adenocarcinoma of endocervical origin, to spread to distant organs without causing gynecological typical clinical signs. Despite regular cervical screening, the absence of high-risk HPV infection, combined with delayed diagnosis due to atypical presentation, aggressive histology, and lack of typical gynecologic symptoms, contributed to the poor prognosis. This clinical case highlights the need for clinicians to consider gynecologic malignancies in women presenting with neurological symptoms, even when clinical suspicion is low. Further research is required to elucidate the molecular pathways facilitating CNS metastases and their negative prognostic implications.