Solitary splenic metastasis of ovarian carcinoma: a case report

Splenic 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.

An 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.

This 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.