Relapse of cervical cancer presenting as symptoms of Collet-Sicard syndrome with metastatic subcutaneous and adrenal deposits.

A 35-year-old woman—who had been diagnosed with stage IB squamous-cell carcinoma of the cervix, treated with Wertheim’s hysterectomy followed by external-beam radiation to the pelvis (50 Gy in 25 fractions over 5 weeks), and disease-free for 13 months—presented to us with recent onset dysphagia, dysarthria, and deviation of the right side of the tongue. Clinical examination revealed palsy of the lower four cranial nerves, shown by loss of gag refl ex, weakness of the right shoulder, and deviation of the tongue and soft palate to the right side. Whole-body 18-fl uorodeoxyglucose-PET ([ 18 F]FDG-PET; the brain was included because of neurological symptoms) showed a curvilinear area of intense uptake of fl uorodeoxyglucose on the right posterior of the skull base (fi gure A). [ 18 F]FDG-PET also revealed abnormal disease foci that were symptomatically silent in: the right adrenal gland (confi rmed by repeat postfurosemide [ 18 F]FDG-PET that was limited to the abdomen), a subcutaneous nodule in the right arm, the mediastinum, and the right iliac bone (fi gure A). The subcutaneous nodule was hitherto unknown and serendipitously discovered by [ 18