Hypercalcemia and Extensive Chest Metastasis of Vulvar Squamous Cell Carcinoma

A 73-year-old woman with a diagnosis of vulvar carcinoma submitted to curative surgery 5 years previously, presented to the emergency department with prostration and vulvar haemorrhage. Although the gynaecological examination was unremarkable, she had a mass in the left chest wall and hypercalcemia. A CT scan of the thorax revealed a voluminous left hemithorax mass invading the mediastinum, lung, pleura and chest wall. Ultrasound-guided biopsy of the mass showed infiltration by a well-differentiated keratinizing squamous cell carcinoma (SCC). This case report describes an extremely rare metastatic pattern in vulvar SCC concomitant with paraneoplastic hypercalcemia. LEARNING POINTS: Pulmonary metastasis of vulvar carcinoma with chest wall invasion should be included in the list of rare manifestations of squamous cell carcinoma. Hypercalcaemia is common in squamous cell carcinoma but rare in vulvar carcinoma, and is associated with a bad prognosis.