Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: A case report and review of the literature

A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned probe curettage was performed and reported as Stage IIa, grade 3, squamous cell carcinoma of the uterine cervix. The patient underwent radical hysterectomy type III, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic para-aortic lymph node dissection according to our clinical protocol. Adjuvant radiation therapy was planned. A splenic mass of 8 cm in diameter was revealed on computed tomography at the end of the third year of the disease-free follow-up period. Fine needle aspiration biopsy was performed and reported as metastatic carcinoma correlated to the previous cervical cancer. Debulking surgery was performed. The patient died one year after the second surgical operation. Spleen metastasis in patients with squamous cell carcinoma of the uterine cervix is exceedingly rare. Nonetheless we recommend screening of all intra-abdominal organs including the spleen as a rare metastastic site in follow-up examination protocols.

Squamous cell carcinoma; Cervix; Splenic metastasis

[1] Hoskins W.J.,P erez C.A.,Y oung R.C.: "Principles and Practice of Gynecologic Oncology", 3rd ed., Philadelphia，LippincottWilliams & Wilkins, 2000, 841.

[2] Blaustein's Pathology of the Female Genital Tract, 5th ed., New York, Springer-Verlag, 2002, 325.

[3] Parente J.T.: "Metastases in cancer of the cervix". Am. J. Surg., 1960, 99, 363.

[4] Brufman G., Biran S., Goldschmidt Z., Freund A.: "Solitary metastatic involvement of spleen in squamous cell carcinoma of the cervix". Harefuah., 1977, 92, 349.

[5] Klein B.,S tein M.,K uten A.,S teiner M.,B urshalom D.,R obinson E., Gal D.: "Splenomegaly and solitary spleen metastasis in solid tumors". Cancer, 1987, 60, 100.

[6] Carlson V., Delclos L., Fletcher G.H.: " Distant metastases in squamous cell carcinoma of the uterine cervix". Radiology, 1967, 88, 961.

[7] Claude J.T., Cash R.B.: "Pulmonary metastasis of carcinoma of the cervix. A retrospective study". Cancer, 1982, 49, 1705.

[8] Kelly J., Parson L., Friedel! G., Sommers S.: "A pathologic study in 55 autopsies after radical surgery for cancer of the cervix". Surg. Gynecol. Obstet., 1960, 110, 427.

[9] Babib O.A.,K urohara S.S.,W ebster H.J.,P ickren W.J.: "Metastasis to organs in carcinoma of the uterine cervix. Influence of treatment on incidence and distribution". Cancer, 1968, 21, 434.

[10] Sotto L.,G raham J.,P ickren J.: "Postmortem findings in cancer of cervix". Am. J. Obstet. Gynecol., 1960, 80, 791.

[11] Marymount J.H. Jr., Gross S.: "Patterns of metastatic cancer in the spleen". Am. J. Clin. Pathol., 1963, 40, 58.

[12] Edelman S.A., Rotterdam H.: "Solitary splenic metastasis of an adenocarcinoma of the lung". Am. J. Clin. Pathol., 1990, 94, 326.

[13] Nathanson L.: " Biological aspects of human malignant melanoma". Cancer, 1967, 20, 650.

[14] Rappaport H.: "Tumors of the hematopoietic system". In Atlas of Tumor Pathology,S ect. 3,F asc. 8,W ashington,D .C. Armed forces Institute of Pathology, 1966, 424.

[15] Jorgensen L.N., Chrintz H.: "Solitary metastatic endometrial camnoma of the spleen". Acta Obstet. Gynecol. Scand., 1988, 67, 91.

[16] Arend P., Amuli M., Algaba R., Blondiau J.V., Wauters G., Chamiec M. et al.: "Solitary splenic metastasis of endometrial adenocarcinoma. A case report and review of the literature". J. Gynecol. Obstet. Biol. Reprod. (Paris), 1992, 21, 182.

[17] Giuliani A., Caporale A., Di Bari M., Demore M., Mingazzini P.: "Isolated splenic metastasis from endometrial carcinoma". J. Exp. Clin. Cancer Res., 1999, 18, 93.

[18] Morgenstern L., Rosenberg J., Geller S.A.: "Tumors of the spleen". World J. Surg., 1985, 9, 468.

[19] Minegawa Y.,K anamori Y.,l shiara H.,M orishita K.,K igewa J.,I to T. et al.: "Solitary metastatic ovarian carcinoma of the spleen. A case report". Asia Oceania J. Obstet Gynaecol., 1991, 17, 45.

[20] Max L.D.,S tastny J.F.,F rable W.J.: "Solitary splenic metastasis of an adenocarcinoma of the ovaries". Gynecol. Obstet. Invest., 1996, 42, 214.

[21] Mastroianni M., Di Vagno G.,M elilli G.A.,L a Presa M., Digesu A., Cazzola A. et al.: "Splenic involvement in ovarian cancer description of three cases". Minerva Ginecol., 2000, 52, 127.

[22] Campagnutta E.,Z arrelli A.,S tefanutti V., CimitanM., Querin F., Scarabelli C.: "Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case". Minerva Ginecol., 1992, 44, 667.

[23] Misonou J., Aizawa M., Nakamura S., Kanda M., Hishiyama H., Atsuta T.: "A rare autopsy involving primary squamous cell carcinoma of the breast showing a very rapid and aggressive clinical course". Gan No Rinsho., 1987, 33, 1833.

[24] Dunn M.A., Goldwein M.I.: "Hypersplenism and advanced breast cancer report of a patient treated with splenectomy". Cancer, 1975, 35, 1449.

[25] Barret O. Jr., Panettiere F., Cohen A.: "Symptomatic hemolytic anemia in carcinoma. Cure with splenectomy". Arch. Surg., 1970, 100, 310.

[26] Stratford E.C. Jr., Tanaka K.R.: "Microangiopathic hemolytic anemia in metastatic carcinoma". Arch. Intern. Med., 1965, 116, 346.