Rapid enlargement of a tubo-ovarian abscess in a patient with cervical cancer and multiple uterine fibroids: A case report

Locally advanced cervical cancer can be complicated by infections such as pyometra and tubo-ovarian abscess (TOA), although the pathogenesis of TOA is not fully understood. This report presents a case of TOA that rapidly enlarged in a patient with cervical cancer and multiple intramural uterine fibroids. A 61-year-old primigravida was diagnosed with stage IIB cervical cancer, classified as cT2bN0M0, squamous cell carcinoma, complicated by multiple fibroids. Concurrent chemoradiotherapy (CCRT) was planned, and the patient was admitted three weeks after her initial visit with lower abdominal pain. Computed tomography revealed an 8 cm TOA, pyometra, and an enlarged appendix. Conservative treatment with trans-cervical drainage and intravenous antibiotics was unsuccessful. Surgical drainage with bilateral adnexectomy and appendectomy was therefore performed. Bacteroides fragilis was identified in intra-abdominal pus cultures, consistent with findings from cervical drainage, suggesting that the TOA developed secondary to pyometra. One month after surgery, CCRT was resumed and completed without complications. TOA associated with cervical cancer can enlarge rapidly and may require surgical drainage. In patients with locally advanced cervical cancer and multiple uterine fibroids, the potentially increased risk of TOA should be considered.