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squamous cell carcinoma of the cervix ( scc ) is the second most common malignancy in women in the developing world .
it spreads locally by direct extension and to the pelvic and extra - pelvic lymph nodes .
the most frequent sites of distant metastasis are the lungs , extrapelvic nodes and liver .
bone metastases in cervical cancer are uncommon . the exact frequency of bone metastasis of cervical cancer is not known but is estimated to be in the range of 0.8%23% ( katz et al . , 1979 ) .
the most frequent site for bone metastasis is the vertebral column ( carlson et al . , 1967 ) followed by the pelvis and long bones ( baid et al . , 1992 ) .
metastatic cervical cancer is usually treated by chemotherapy , and median survival in the most recent reports is about 13.3  months .
incorporation of bevacizumab to chemotherapy significantly improved the median overall survival to 17  months ( tewari et al . , 2014 ) .
however , in patients that present with a solitary disease site , aggressive local treatment can sometimes result in prolonged survival .
selected cases with lung metastases can achieve long term remission following pulmonary resection ( anderson et al . , 2001 ) . in one report ,
the 5  year survival for patients who underwent pulmonary metastastectomy was 46.8% ( anraku et al . , 2004 ) .
patients with isolated recurrence in the paraaortic lymph nodes can be treated with concomitant chemo - radiotherapy and 5-year survival rates between 30 and 50% have been reported ( chou et al . , 2001 ) .
it appears that asymptomatic paraaortic recurrence which is detected by routine imagining carries a higher salvage rate than symptomatic recurrence ( singh et al . , 2005 ) .
we report an unusual case of an isolated metastasis of cervical cancer to the fronto - parietal bone .
the patient was treated by local surgery and radiotherapy and remained disease free for 20  months .
a 58  year - old woman presented with postmenopausal bleeding and was diagnosed with squamous cell carcinoma of the uterine cervix figo stage iib . pet 
ct scan 8  months after completion of initial therapy detected a small area of positive uptake in the cervix without evidence of pelvic nodal involvement .
biopsies from the cervix were non - conclusive and the patient underwent a simple hysterectomy and bilateral salpingo - oophorectomy .
pathological assessment did not reveal evidence of residual tumor . physical examination and pet  ct 5  months later were negative for metastatic disease .
seven months after surgery the patient complained of headaches and a fast growing lump on the right forehead .
a lesion on her right fronto - parietal bone was palpated and no neurologic deficits were noted .
ct scan of the brain revealed a solitary lytic lesion confined solely to the fronto - parietal bone .
bone scintigraphy and single - photon emission computed tomography ( spect ) revealed the same finding as well ( fig .  1 ) .
pathology findings were consistent with scc identical to the primary tumor ( fig .  2 ) .
the patient was well and free of recurrent disease for 20  months , when metastases to the para - aortic lymph nodes were diagnosed .
( rath et al . , 2000 ) reported a case with multiple metastases to the scalp in a patient treated with radiotherapy for a figo stage iiib tumor .
( yanuck et al . , 1991 ) reported on a 21  year - old woman with stage iv cervical cancer that presented with a mass on the frontal bone .
cases with a solitary skull lesion are rare and only several were reported in the english literature ( niloofar ahmadloo et al . , 2010 ,
, 2002 ; abhishek et al . , 2008 ; mohanty et al . , 2010 )
that have been described skull metastases developed after treatment for advanced stage primary disease , reflecting the tendency of cervical cancer to spread to the lymphatic system before hematogenous spread occurs . in our unique case
the clinical stage at diagnosis was ii - b and the scalp metastasis was diagnosed after a relatively long ( 15  months ) disease free interval .
the presenting symptoms of scalp metastases in the cases described were headache or a palpable mass in the calvarium .
skeletal metastasis from cervical carcinoma usually carries a poor prognosis and life expectancy is less than twelve months after diagnosis , regardless of the duration of disease free interval ( baid et al . ,
treatment is usually directed toward maintaining quality of life and includes local palliation with radiotherapy or surgery and systemic chemotherapy .
as mentioned above , isolated recurrence of cervical cancer to the lungs and paraaortic lymph nodes can be cured with radical therapy .
described a case of solitary metastasis of cervical cancer to the fibula that was treated with surgery and radiotherapy .
after more than 3  years of follow - up the patient was free of disease ( pasricha et al . , 2006 ) .
in our case radical treatment also resulted in a relatively prolonged ( 20  months ) disease free survival , after which another potentially curable recurrence in the para - aortic lymph nodes was diagnosed .
notably , both cases developed after initial treatment of a figo stage ii primary disease .
this case highlights the need to address unusual symptoms in patients that have been treated for primary cervical cancer as this disease may spread to unusual sites .
moreover , it demonstrates that selected patients can achieve a long term disease free survival following radical therapy for an isolated bone recurrence .
we , the authors of the following manuscript , declare that we have no conflicts of interest regarding this submitted paper .
a 58  years old woman was diagnosed with squamous cell carcinoma of the uterine cervix figo stage iib and was treated by concomitant radio - chemotherapy followed by simple hysterectomy . 
 several months later a single metastasis to the skull was diagnosed . 
 the patient underwent craniotomy and radiotherapy and achieved a prolonged disease free survival of 20  months.bone metastases from cervical carcinoma are usually part of widespread metastatic disease . 
 skull metastases are extremely rare . selected cases of solitary bone metastases 
 can be treated radically and achieve long term disease free survival .