Management of a solitary splenic metastasis in the tubal carcinoma. A case report with review of the literature.
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We encountered a rare case of solitary splenic metastasis from adenocarcinoma of the fallopian tube. A 57-year-old woman, (gravida 5, para 3) underwent laparotomy for a pelvic tumor in April 1992. The lesion arose from the right fallopian tube with metastases to the left tube and the omentum. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed. Pathological examination revealed serous adenocarcinoma of the right fallopian tube (FIGO stage IIIc). There was no residual tumor in the abdominal cavity and cytology of ascites was negative. After two courses of intraperitoneal CDDP and 2 courses of systemic VAB 6chemotherapy, a second look operation was performed. Pelvic and para-aortic lymphadenectomy revealed no lymph node metastasis. Then she received one course of intraperitoneal CDDP and 1 course of systemic VAB 6. We had followed her as an outpatient from May 1995 and the course had been uneventful. However, a solitary splenic tumor was detected by ultrasonography, CT, and MRI in January 1998. Laparoscopy revealed a splenic tumor invading the stomach, omentum and pancreas without any other signs of recurrence. Splenectomy was performed laparoscopically together with omentectomy, and partial resection of the stomach and pancreas. The histopathological features were similar to those of the original tubal carcinoma, and the diagnosis of solitary splenic metastasis from adenocarcinoma of the fallopian tube was confirmed. Her postoperative course has been uneventful and there have been no signs of recurrence. In this case, ultrasonography was useful for detection of the splenic tumor. It was suggested that splenectomy should be considered for a solitary splenic metastasis and may be the most appropriate management. [Adv Obstet Gynecol 51 (5); 489 495, 1999 (H.11.9)]
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