Laparoscopic Splenectomy as Quaternary Cytoreduction for Isolated Parenchymal Splenic Recurrence of Epitelial Tubo-Ovarian Cancer: Report of a Case and Literature Review

Abstract

Isolated parenchymal splenic lesions are very rare and may occur as recurrences in the form of epithelial tubo-ovarian cancer (ETOC). We report a case of solitary parenchymal splenic recurrence of ETOC, which developed 50 months after the initial treatment. A 66-year-old woman underwent laparotomic primary cytoreduction in 2008. After platinum-based chemotherapy, she developed recurrences; thus, she underwent secondary and tertiary cytoreduction in 2011 and 2012 respectively. In April 2013, CT scan documented a solitary parenchymal splenic lesion and it was confirmed by FDG PET/CT. She underwent quaternary cytoreduction by laparoscopic splenectomy. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ETOC. She was alive and disease-free for ten months since splenectomy. In literature there are 35 cases of isolated spleen parenchymal metastasis of ETOC and our report is the first case of laparoscopic splenectomy in the setting of quaternary cytoreduction. Laparoscopic splenectomy as quaternary cytoreduction is safe and feasible and could be congruent to the well-established experiences already reported for the primary, secondary or even tertiary cytoreduction where the absence of residual disease has been translated in a significant survival benefit.

Upgrade of an old drug: Auranofin in innovative cancer therapies to overcome drug resistance and to increase drug effectiveness

“…The cornerstone of treatment is maximal‐effort surgical cytoreduction combined with cytotoxic chemotherapy. An estimated 80%–85% of patients with OC who achieve full remission following first‐line platinum‐based therapy will develop recurrent disease and median survival for these patients ranges from 12 months to 24 months 101 . Except for bevacizumab and poly ADP‐ribose polymerase inhibitors, approved for BRCA1/2 mutated patients and for platinum‐sensitive patients without BRCA 1/2 mutation, there are few other options for women with platinum‐resistant OC.…”

The first case report of a solitary metastasis of the transitional cell carcinoma of the ovary to the spleen

“…A literature review by Izuishi et al 15 in 2010 showed that 27% of all solitary splenic metastases arise from ovarian cancer. Bearing in mind that there are several papers published before the year 2000 16 , Table 1 contains short descriptions of solitary ovarian cancer metastases to the spleen published in the relevant literature as of the year 2000 (also, there are several papers published before the year 2000) [17][18][19][20][21][22][23][24][25] . Based on the literature review, we can conclude that this is the first reported case of a solitary splenic metastasis of primary ovarian TCC.…”

Laparoscopic splenectomy for solitary splenic metastasis in a patient with ovarian cancer with a long disease-free interval: a case report

“…Although our case involved laparoscopic splenectomy as tertiary cytoreduction, the operation was performed successfully and the postoperative course was uneventful. Recently, another case of laparoscopic splenectomy as quaternary cytoreduction was reported to have been performed successfully [ 15 ].…”

“…Therefore, it is difficult to diagnose solitary splenic metastasis early. However, serum CA125 is useful to diagnose asymptomatic solitary splenic metastasis of ovarian cancer because the majority of cases show an increase in serum CA125 level [ 15 ]. Our case also showed no symptoms, but the serum CA125 level was elevated before imaging, indicating the presence of the splenic metastasis.…”