Abstract
IntroductionSplenic metastasis from ovarian carcinoma generally presents as peritoneal spread with multiorgan involvement. Fewer than 30 cases of solitary parenchymal splenic metastasis from ovarian carcinoma have been published in the literature. The presentation is often asymptomatic.Case presentationAn increase in tumor marker CA-125 from 18.1 to 132.6 units/ml (normal <35 units/ml) was measured in a 56-year-old Israeli Jewish woman who had undergone, six years previously, a total abdominal hysterectomy with bilateral salpingo-oophorectomy due to right ovarian carcinoma. An abdominal computed tomography scan revealed a mass of 6×8cm at the anterior of the spleen, with close proximity to the wall of the stomach. A gastroscopy demonstrated exterior pressure on the stomach body. An open splenectomy was performed to exclude a peritoneal carcinomatosis. No intraoperative evidence of tumoral spreading in the abdominal cavity was observed, other than the spleen. The final histologic result demonstrated a high-grade carcinoma consistent with metastatic endometrioid-type ovarian carcinoma grade 3.ConclusionsThis case highlights the importance of cancer antigen 125 assessment and medical imaging in the follow-up of ovarian carcinoma. Open laparotomy, or laparoscopy, enables exclusion of a peritoneal carcinomatosis, which is more common than solitary parenchymal splenic metastasis, as was presented in the current case.
Highlights
Splenic metastasis from ovarian carcinoma generally presents as peritoneal spread with multiorgan involvement
This case highlights the importance of cancer antigen 125 assessment and medical imaging in the follow-up of ovarian carcinoma
Laparoscopy, enables exclusion of a peritoneal carcinomatosis, which is more common than solitary parenchymal splenic metastasis, as was presented in the current case
Summary
The current case highlights that splenic metastasis should be suspected when an elevated CA-125 level is measured during follow-up of ovarian carcinoma, and should be confirmed using imaging studies such as ultrasound and CT scan. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Authors’ contributions DK (Dror Karni), a third-year resident, participated in the operation, conducted the literature review and wrote the first draft of this case report. DK (Doron Kopelman), the Head of General Surgery B’ at Haemek Medical Center, helped in writing the manuscript, and approved the final version. OAH was the leading surgeon who performed the operation, and a major contributor to writing the manuscript. All authors read and approved the final manuscript
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