Solitary Splenic Metastasis Αfter Surgically-treated Cervical Cancer – A Case Report and Literature Review

Abstract

Abstract. Background Cervical cancer remains one of the most common gynecologic malignancies worldwide; although association of oncologic treatment is widely performed, a number of cases will develop, at a certain moment, distant metastases (1, 2). Unfortunately, most patients in this situation will be diagnosed with disseminated secondary lesions, being candidates only for palliative treatment. In rare cases, solitary metastases have been reported, transforming the patient into the perfect candidate for re-operation. We present the case of a 31-year-old patient diagnosed with an isolated splenic recurrence 18 months after surgically-treated cervical cancer. Case ReportWe present the case of a 31-year-old patient who initially presented to our service for pelvic pain and massive vaginal bleeding. At that moment, a cervical biopsy revealed the presence of a moderately differentiated squamous cell cervical cancer. The preoperative investigations revealed a stage IIB cervical tumor, so the patient was submitted to neoadjuvant chemotherapy and radiation therapy followed by surgery; a total radical hysterectomy en bloc, with bilateral adnexectomy and pelvic lymph node dissection was performed. The histopathological studies confirmed the presence of an area of 5 mm with 4-mm deep invasion with malignant transformation; in the meantime, the histopathological evaluation of the lymph nodes revealed the absence of tumoral invasion in none of the retrieved lymph nodes (eleven left side lymph nodes and seven right side lymph nodes). These findings classified the lesion as a T1a2, pN0, M0 cervical cancer. At 18 months follow-up, the patient was diagnosed with an isolated tumoral mass of 5/5 cm located in the splenic hylum, so the patient was re-operated. Intraoperatively, the diagnostic of solitary splenic lesion was confirmed, so the patient was submitted to splenectomy (Figures 1-5). The postoperative course was uneventful, with the patient being discharged in the fifth postoperative day. The histopathological study revealed the presence of a 5/5 cm lesion with a typical aspect of a splenic metastasis of a moderately differentiated squamous cell cervical cancer. One month after discharge, the patient was submitted to adjuvant chemotherapy consisting of six cycles of cisplatin and paclitaxel. At one year follow-up, the patient is free of any recurrent disease or distant metastases. DiscussionCervical cancer has a high propensity of local spread, after destroying the natural compartmental borders, leading to the apparition of pelvic masses involving the urinary bladder and/or 2615

Radical Hysterectomy for Cervical Cancer in Patients With Uterine Prolapse

“…However, a wide implementation of screening tests has led to a decrease in the incidence of the malignancy in the last decades. In our country, unfortunately, cervical cancer still represents a significant health problem affecting women in all ages (8)(9)(10)(11)(12)(13). When it comes to the possibility of association of these two entities, different theories have been proposed so far.…”

The clinical course and management of cervical cancer with splenic metastasis: Case report and review of the literature

“…As reported in the literature, the incidence of splenic metastases from cervical cancer ranged from 1/92 to 8/108 in autopsy cases 4 . To the best of our knowledge, only 17 cases of splenic metastasis resulting from cervical cancer have been reported in the literature (Supplementary Table ), including ours 5‐15 . The stages of the 17‐splenic metastasis retrieved from the literature were as follows: 11.76% (2/17) in stage IB, 23.53% (4/17) in stage IIA, 47.06% (8/17) in stage IIB, 5.88% (1/17) in stage IIIB, and 5.88%(1/17) in stage IVA.…”

Solitary splenic metastasis in a case of treated cervical cancer: a case report

“…14 According to a case report by Dixit et al, which reported splenic metastasis at 17 months after completion of the oncological treatment for squamous cell cervical cancer, only 11 cases had been published before, with their case being the 12 th reported ever. 6 Most of the literature available until today focuses on scattered case reports, as well as autopsy series between 20-80 years ago. Lack of information is thought to be due to selection bias and an overall decrease in the number of subjects undergoing autopsy.…”