1
|
Klamminger GG, Burgard C, Rosar F, Altmeyer K, Malinowski M, Nigdelis MP, Stahl PR, Solomayer EF, Hamoud BH. Unusual Case of Splenic Metastasis in Adenosquamous Carcinoma of the Cervix Uteri: Diagnosis and Treatment Considerations. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941600. [PMID: 38062677 PMCID: PMC10720923 DOI: 10.12659/ajcr.941600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/02/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Due to several factors such as its specific cellular and biochemical microenvironment, the spleen is not a predestined organ of frequent metastatic colonization in the case of primary solid carcinoma. Hence, the mode of diagnosis and the preferred treatment of a lesion highly suspicious of splenic metastasis must be decided on a case-by-case basis, considering not only the biological tumor entity but also the stage of the primary disease. CASE REPORT In the present case, we demonstrate the clinical course of a 37-year-old female patient who initially presented to our clinic with irregular vaginal bleeding. A consecutive gynecological examination revealed a 3×3-cm large mass of the cervix uteri, and the subsequent histomorphological workup led to the diagnosis of an adenosquamous carcinoma of the cervix uteri. Therapeutically, the patient received multimodal treatment, namely radical hysterectomy with adjuvant radio-chemotherapy. After 1.5 years, the patient presented to our Emergency Department with intermittent left-sided abdominal pain. Subsequent abdominal imaging (computed tomography scan, magnetic resonance imaging, positron emission tomography) determined a metabolically active splenic lesion with a central necrosis - signs of malignancy in line with a splenic metastasis. Presentation and discussion of the case within our interdisciplinary tumor board led to the decision of splenectomy followed by chemotherapy, a procedure that could be considered as therapeutic treatment in such exceptional cases. CONCLUSIONS The collection and reporting of atypical clinical courses remains a key factor in precision medicine to enable the most evidence-based decision making in such cases.
Collapse
Affiliation(s)
- Gilbert Georg Klamminger
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany
- Department of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Caroline Burgard
- Department of Nuclear Medicine, Saarland University, Homburg, Saar, Germany
| | - Florian Rosar
- Department of Nuclear Medicine, Saarland University, Homburg, Saar, Germany
| | - Katrin Altmeyer
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Maciej Malinowski
- Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Meletios P. Nigdelis
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany
| | - Phillip Rolf Stahl
- Department of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Erich Franz Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany
| |
Collapse
|