PP 50. Is It Just Splenectomy? A Case of Ginormous Splenic Metastasis Treated Surgically

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S. Anwar, S. Mehmood, M. Siraj Ali, F. Siddiqui, R. Soomro

18:40 - 18:46h at Lanchid Room

Categories: Poster Session , Surgical Oncology

Session: Poster (P4) - Surgical Oncology

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Background
Parenchymal splenic metastasis is uncommon and has been reported to pose significant diagnostic and technical challenge. We report a case of ginormous spleen with parenchymal lesions of ovarian origin.

Material and Methods
A 32-year-old lady presented with a large mass in the abdomen associated with significant discomfort, breathing difficulties, and impaired quality of life. Some three years ago, she was treated with neoadjuvant chemotherapy, abdominal hysterectomy, bilateral salpingo-oopherectomy, and omentectomy for ovarian adenocarcinoma with omental and para-aortic nodal metastases. Abdominal examination revealed marked distension with a large palpable mass. An elevation in CA- 125 levels (233 U/mL) suggested recurrent ovarian cancer and a CT scan revealed a large cystic mass arising from spleen, measuring 25x20 cm, along with liver lesions.

Result
In view of potential resectability of the mass, a palliative resection was offered. At laparotomy, spleen was noted to be transformed into a huge mass occupying all quadrants. The splenic mass was resected intact and the specimen weighed seven kilograms. The histological examination confirmed parenchymal metastasis from ovarian cystadenocarcinoma. The patient recovered well after a prolonged hospital stay.

Conclusion
Spleen remains an infrequent site for metastatic disease with up to 0.6% and 7.3% of spleens showing malignant deposits at autopsy and pathological assessments, respectively. Direct peritoneal spread with capsular splenic metastases are not uncommon, however, parenchymal deposits from a rare event and represent hematogenous dissemination. Most splenic metastases originate from solid tumours below the diaphragm and open surgical resection is the mainstay of treatment if deemed operable.