Metastasis of uterine carcinosarcoma to the accessory spleen: an unusual recurrence pattern

Patients with uterine carcinosarcoma have poor prognoses, and the disease frequently metastasizes to the abdominal cavity. Uterine tumor metastasis to an accessory spleen has never been reported previously. The authors report a 68-year-old Japanese woman with uterine carcinosarcoma recurring in an accessory spleen 12 years after initial hysterectomy. This solitary recurrent lesion was successfully resected and it comprised metastatic tumor cells that closely resembled a primary uterine carcinosarcoma. This case demonstrates that uterine carcinosarcoma is able to metastasize to an accessory spleen and this is the rare case of a long-term survival of a uterine carcinosarcoma patient. The authors propose that complete surgical resection of the recurrent lesion will contribute beneficially to patient survival.

Accessory spleen; Uterine carcinosarcoma; Recurrence.

[1] Ali S., Wells M.: “Mixed mullerian tumors of the uterine corpus: a review”. Int. J Gynecol. Cancer., 1993, 3, 1.

[2] Gonzalez Bosquet J., Terstriep S.A., Cliby W.A., Brown-Jones M., Kaur J.S., Podratz K.C., et al.: “The impact of multi-modal therapy on survival for uterine carcinosarcomas”. Gynecol. Oncol., 2010, 116, 419.

[3] Sartori E., Bazzurini L., Gadducci A., Landoni F., Lissoni A., Maggino T., et al.: “Carcinosarcoma of the uterus: A clinicopathological multicenter CTF study”. Gynecol. Oncol., 1997, 67, 70.

[4] Callister M., Ramondetta L.M., Jhingran A., Burke T.W., Eifel P.J.: “Malignant mixed müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome”. Int. J of Radiat. Oncol. Biol. Phys., 2004, 58, 786.

[5] Kim S.H., Lee J.M., Han J.K., Lee J.Y., Kim K.W., Cho K.C., et al.: “Intrapancreatic accessory spleen: Findings on mr imaging, CT, US and scintigraphy, and the pathologic analysis”. Korean. J. Radiol., 2008, 9, 162.

[6] Mortele K.J., Mortele B.,Silverman S.G.: “CT features of the accessory spleen”. AJR Am. J. Roentgenol., 2004, 183, 1653.

[7] Yamaoka R., Nishihira T., Shimada T., Nishimura M., Inoue H., Yasuda K., et al.: “Adenocarcinoma in an intrapancreatic accessoryspleen: Report of a case”. Surg. Today, 2011, 41, 1552.

[8] Zavras N., Machairas N., Foukas P., Lazaris A., Patapis P., Machairas A.: “Epidermoid cyst of an intrapancreatic accessory spleen: A case report and literature review.”. World J. Surg. Oncol., 2014, 12, 92.

[9] Hori S., Nara S., Shimada K., Ojima H., Kanai Y.,Hiraoka N.: “Serous cystic neoplasm in an intrapancreatic accessory spleen”. Pathol. Int., 2010, 60, 681.

[10] Mihmanli V., Toprakci G., Cetinkaya N., Kilickaya A., Kamali G.: “Intraparenchymal metastasis to the accessory spleen from ovarian cancer: a case report”. Eur. J. Gynaecol. Oncol., 2013, 34, 580.

[11] SpanosW.J.Jr., Peters L.J., Oswald M.J.: “Patterns of recurrence in malignant mixed mullerian tumor of the uterus”. Cancer, 1986, 57, 155.

[12] Giuntoli R.L. II, Garrett-Mayer E., Bristow R.E., Gostout B.S.: “Secondary cytoreduction in the management of recurrent uterine leiomyosarcoma”. Gynecol. Oncol., 2007, 106, 82.

[13] Barney B.M., Petersen I.A., Dowdy S.C., Bakkum-Gamez J.N., Haddock M.G.: “Long-term outcomes with intraoperative radiotherapy as a component of treatment for locally advanced or recurrent uterine sarcoma”. Int. J. Radiat. Oncol. Biol. Phys., 2012, 83, 191.

[14] Shamseddine A., Taher A., Abou-Mourad Y., Seoud M., Khalil A.: “Cure of metastatic uterine carcinosarcoma to lungs: A case report”. Int. J. Gynecol. Cancer, 2003, 13, 88.