Metastatic involvement of the spleen by endometrial adenocarcioma; a rare asylum for a common malignancy: a case report

BMC Research Notes

Asif Zafar Malik²  Tariq Nawaz²  Muhammad Atif Khan¹  Naeem Zia²  Zain Ul Abideen³  Adnan Arif¹ 

[1] Surgical Unit 2, Holy Family Hospital, Satellite town, Rawalpindi, Pakistan;Surgical Unit 2, Holy Family Hospital , Rawalpindi Medical College, Rawalpindi, Pakistan;Department of Anesthesia, Pain and Intensive care, Holy Family Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan

关键词: Ultrasonography;    Computerized tomography;    Splenectomy;    Endometrial adenocarcinoma;    Splenic metastasis;   

Others  :  1140744
DOI  :  10.1186/1756-0500-6-476

 received in 2013-04-11, accepted in 2013-11-18,  发布年份 2013

【 摘 要 】

Background

Metastatic involvement of the spleen by solid tumors is a rare clinical entity; those coming from endometrial adenocarcinomas are exceptionally rare. Spleen is an uncommon site for metastatic deposits due to its specific anatomy and microenvironment. Typically, splenic metastasis from endometrial carcinomas present months to years after curative surgery, chemotherapy or radiotherapy. The most common complaint in symptomatic patients is abdominal pain localized to the left hypochondrium. Most however, are asymptomatic only to be picked up on vigilant routine ultrasonography or computerized tomography during follow up. We report the case of a 54-year-old woman who presented to us after 50 months of total abdominal hysterectomy and bilateral salpingo-oophorectomy for an endometrial adenocarcinoma. She had severe abdominal pain localized to the left hypochondrium as the presenting complaint. To the best of our knowledge, this is the 1^st case to be reported from Pakistan with 14 cases reported prior to our report. All past cases report the endometroid variant of endometrial adenocarcinoma as the primary tumor and our patient was a victim to the same variant.

Case presentation

A 54-year-old, nulliparous widowed woman presented with severe abdominal pain in the left hypochondrium for the last 4 months. The pain radiated to the left shoulder and was exacerbated with deep breathing. She had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy done 50 months back for stage 1a endometroid endometrial adenocarcinoma. Clinical examination revealed tenderness in the left hypochondrium but no visceromeglay was appreciable. Ultrasonography and computerized tomography revealed a space-occupying lesion within the spleen with associated splenomegaly. Computed tomography further suggested a large splenic abscess however the patient did not have fever, vomiting or leukocytosis which are the hallmarks of a splenic abscess. A splenectomy was performed for her complaints. On histopathology a metastatic adenocarcinoma was identified consistent with the primary tumor. The tumor was CK7, CA-125 and epithelial membrane antigen positive (EMA). The patient was then referred for further chemotherapy.

Conclusion

From this case we conclude, that although very rare, the spleen is a potential site for metastasis in endometroid endometrial adenocarcinoma. Since most patients are asymptomatic, routine examinations and imaging can identify its presence and avoid complications. If the practice is employed with vigilance, we may expect the clinical event to be diagnosed more frequently. The standard treatment is a classic splenectomy followed by chemotherapy.

【 授权许可】

   
2013 Arif et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Compérat E, Bardier-Dupas A, Camparo P, Capron F, Charlotte F: Splenic metastases clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med 2007, 131:965-969.
• [2]Piura E, Piura B: Splenic metastases from female genital tract malignancies. Harefuah 2010, 149:315-320. 335, 334
• [3]Gogas H, Ignatiadis T, Markopoulos C, Karageorgopoulou S, Floros D, Vaiopoulos G: Solitary spleen metastasis and amyloidosis in a patient with endometrial cancer. Eur J Gynaecol Oncol 2004, 25:391-393.
• [4]La Fianza A, Madonia L: Splenic metastases in gynaecologic cancer: clinical considerations, US, and CT diagnostic results. Radiol Med 2003, 106:36-43.
• [5]Lagendijk JH, Mullink H, van Diest PJ, Meijer GA, Meijer CJ: Immunohistochemical differentiation between primary adenocarcinomas of the ovary and ovarian metastases of colonic and breast origin. Comparison between a statistical and an intuitive approach. J Clin Pathol 1999, 52:283-290.
• [6]Lagendijk JH, Mullink H, Van Diest PJ, Meijer GA, Meijer CJ: Tracing the origin of adenocarcinomas with unknown primary using immunohistochemistry: differential diagnosis between colonic and ovarian carcinomas as primary sites. Hum Pathol 1998, 29:491-497.
• [7]Albarracin CT, Jafri J, Montag AG, Hart J, Kuan SF: Differential expression of MUC2 and MUC5AC mucin genes in primary ovarian and metastatic colonic carcinoma. Hum Pathol 2000, 31:672-677.
• [8]Berge T: Splenic metastases: frequencies and patterns. Acta Pathol Microbiol Scand 1974, 82:499-506.
• [9]Zhang ZX, Fang Z, Ye JP, Tao C, Yi M, Lu H: Diagnosis and clinicopathologic features of metastatic carcinoma to the spleen. Chin J Surg 2002, 40:585-588.
• [10]Hanson MB, van Nagell JR, Powell DE, Donaldson ES, Gallion H, Merhige M, Pavlik EJ: The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer [abstract]. Cancer 1985, 55:1753-1757.
• [11]Nori D, Hilaris BS, Tome M, Lewis JL, Birnbaum S, Fuks Z: Combined surgery and radiation in endometrial carcinoma: an analysis of prognostic factors [abstract]. Int J Radiat Oncol Biol Phys 1987, 13:489-497.
• [12]Piura B, Rabinovich A, Apel-Sarid L, Shaco-Levy R: Splenic metastasis from endometrial carcinoma: report of a case and review of literature. Arch Gynecol Obstet 2009, 280:1001-1006.