Isolated Splenic Parenchymal Recurrence in a Case of Carcinoma Ovary

Abstract

Ovarian cancer has emerged as one of the most common malignancies in women in India. Majority of the ovarian cancers present at advanced stage, and, unfortunately, most of them are known to relapse after primary treatment. The pattern of recurrence is usually as disseminated disease. Although metastatic involvement of spleen is common in disseminated recurrences, isolated metastasis in spleen parenchyma is uncommon. We hereby report this rare case of isolated parenchymal splenic recurrence of epithelial ovarian cancer which developed 48 months after the initial treatment. The patient, a 40-year-old woman, with a preoperative diagnosis of Stage IIIB carcinoma ovary, underwent total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH & BSO), omentectomy and pelvic lymph node sampling for a papillary serous carcinoma of the ovaries. She subsequently received six cycles of adjuvant chemotherapy. During follow-up, she was detected to have splenomegaly, along with rising levels of serum CA 125. CT scan revealed the 6 × 7 cm parenchymal splenic lesion. She was taken up for surgery and was detected to have isolated splenic mass. She underwent splenectomy. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ovarian cancer. She remains alive and disease free for 14 months since the last operation. Isolated parenchymal splenic lesions are very rare and may occur as a late recurrence in epithelial ovarian cancer. Splenectomy can be performed with acceptable morbidity and confers a substantial survival benefit to the patients.