Case notes

A 68-year-old woman with stage IV cervical carcinoma had a 1-month history of an enlarged painful clitoris. Initially, she had been diagnosed with a urinary tract infection and received 1 week of oral antibiotics. The following week, an abscess was suspected, and antibiotics were continued for 2 more weeks. Her condition failed to improve. Her history was significant for aortic and mitral valve replacements. She received anticoagulation with warfarin. Because the pain persisted and she was unable to tolerate a biopsy in the office, along with the concern for bleeding, she was taken to the operating room for examination under anesthesia. Examination under anesthesia revealed a firm, vascularized clitoris measuring 1.75 × 1 cm. When the prepuce was retracted, a clitoral base ridge was demonstrated ( Figure ). A clitorectomy was performed to alleviate her clitorodynia. The pathology report showed a metastatic, moderate-to-well differentiated adenocarcinoma from the cervix. The surgery relieved her pain. She received chemoradiation for metastatic cervical cancer. She died 7 months later of complications from metastatic disease.

The clitoris examined under anesthesia

The image on the left shows an enlarged clitoris. The image on the right shows a prepuce that is retracted, revealing a clitoral base ridge (arrow) .

Papoutsis. Metastatic adenocarcinoma to the clitoris from the cervix. Am J Obstet Gynecol 2015 .

Conclusions

Clitoral metastases of primary tumors are rare and can originate from the bladder and kidneys, endometrium, gastrointestinal system, and breast. Metastasis of cervical carcinoma to the clitoris is extremely rare. The route of tumor spreading remains unclear; in almost all cases, there is occurrence of pain and enlargement of the clitoris. The differential diagnosis of clitoral enlargement and pain includes hypertrophy of the clitoris (hormonal secretion from ovarian or adrenal tumors), clitoral cysts (inclusion/epidermoid cysts, mesonephric or paramesonephric cysts, sebaceous cysts), benign (dermoid cysts, fibromas, leiomyomas, angiokeratomas, pseudolymphomas, hemangiomas, granular cell tumors, and neurofibromas), and malignant tumors, varicosities, priapism, and infections. Patients should be examined carefully, ideally, if tolerated, in the clinic setting. It is important to guide the patient through the examination process at all times. If significant pain is present, examination under anesthesia is recommended.

Our case provides images of this rare entity and highlights the fact that, in a patient with a painful and enlarged clitoris in the setting of a previous malignant tumor, the possibility of clitoral metastasis, even though rare, should be considered.