Papillary serous carcinoma is a rare and aggressive form of endometrial cancer, known for its tendency to spread beyond the uterus. While it typically metastasizes to the peritoneum, lymph nodes, and lungs, isolated splenic metastasis is extremely rare. In this report, we present a case of a 66-year-old woman diagnosed with papillary serous endometrial carcinoma, who later developed an isolated splenic metastasis followed by a recurrence in the splenic bed.
Case Overview
A 66-year-old woman with a history of hypertension, diabetes, and hyperlipidemia was initially diagnosed with papillary serous endometrial carcinoma after experiencing postmenopausal bleeding. She underwent surgical staging, including a total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy, followed by adjuvant chemotherapy. Two years later, routine imaging revealed a solitary splenic lesion, prompting a splenectomy. Histopathological analysis confirmed metastatic papillary serous carcinoma.
Despite the splenectomy, the patient later presented with fatigue and left upper quadrant pain. Imaging showed a mass in the splenic bed, and recurrence of the malignancy was confirmed upon histopathological evaluation. This case highlights the rare possibility of late isolated splenic metastasis and recurrence after splenectomy in patients with papillary serous endometrial cancer.
Introduction to Papillary Serous Endometrial Carcinoma
Endometrial cancer is the most common gynecologic malignancy in developed countries, with papillary serous carcinoma making up less than 10% of cases. However, it contributes disproportionately to cancer-related mortality due to its aggressive nature and tendency to metastasize. The most common sites of distant metastasis include the lungs, liver, peritoneum, and lymph nodes. In contrast, splenic metastasis is extremely rare in solid tumors, including endometrial cancer. Even fewer cases involve papillary serous carcinoma.
Hypotheses for the rarity of splenic metastasis suggest the spleen’s unique anatomical and immunological characteristics may hinder tumor cell implantation and growth. The spleen’s circulation and absence of afferent lymphatic channels are thought to limit the likelihood of metastasis.
Case Presentation
The patient, a 66-year-old multiparous woman, presented with postmenopausal bleeding. Imaging revealed a suspicious mass in the endometrium, which was later confirmed as papillary serous endometrial carcinoma. She underwent a total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Histopathological results confirmed grade 3 papillary serous carcinoma with lymphovascular invasion.
Two years later, imaging showed a solitary splenic lesion, which led to a splenectomy. The patient recovered uneventfully. However, months later, she developed acute kidney injury and was admitted for sepsis. Imaging revealed a recurrence in the splenic bed, confirmed by histopathology as metastatic carcinoma.
Discussion
Splenic metastasis from endometrial carcinoma is an extremely rare event, with very few documented cases. Among these, papillary serous carcinoma is even rarer. The spleen’s anatomical and microenvironmental factors are believed to limit the spread of tumor cells, explaining why isolated splenic metastasis is so uncommon. In most cases, splenic metastases occur years after the initial diagnosis, often as a solitary lesion.
This patient’s case adds to the limited body of literature on isolated splenic metastasis in endometrial cancer, specifically the papillary serous subtype. The recurrence in the splenic bed after splenectomy is also noteworthy, as it highlights the potential for delayed recurrence in unusual sites.
Conclusion
This case underscores the importance of long-term surveillance in patients with papillary serous endometrial carcinoma, as well as the need for awareness of atypical metastatic patterns. While splenic metastasis remains an exceptionally rare occurrence, its potential for late recurrence should be considered in managing these patients. This report emphasizes the value of individualized, multidisciplinary care in complex clinical scenarios.
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