Arch Gynecol Obstet (2009) 280:1001–1006 DOI 10.1007/s00404-009-1039-7 123 CASE REPORT Splenic metastasis from endometrial carcinoma: report of a case and review of literature Benjamin Piura · Alex Rabinovich · Liat Apel-Sarid · Ruthy Shaco-Levy Received: 12 January 2009 / Accepted: 5 March 2009 / Published online: 21 March 2009  Springer-Verlag 2009 Abstract Introduction Splenic metastasis from endometrial carci- noma is a rare clinical event, with only 11 cases docu- mented previously in the literature. Case report A 58-year-old woman had surgery and radio- therapy for stage IIB endometrial carcinoma. Eighteen months later, PET scan discovered a hypermetabolic splenic mass and two hypermetabolic lung nodules. Spleen biopsy showed metastasis from endometrial carcinoma. Chemotherapy with six cycles of cyclophosphamide, adria- mycin and cisplatin eVected a partial response of the splenic and lung metastasis. After few months, however, splenectomy was performed because of substantial growth of the spelnic metastasis and it conWrmed that the splenic metastasis was of endometrial origin and solitary in the peritoneal cavity. After splenectomy, the patient received chemotherapy with six cycles of paclitaxel. To date, 6 months after splenectomy, she is alive with no intraperi- toneal disease and with few stable lung metastases. Conclusion This is the 12th reported case of splenic metastasis from endometrial carcinoma. Splenic metastasis from endometrial carcinoma is usually solitary splenic metastasis limited to the splenic parenchyma. Splenectomy is an appropriate treatment to avoid splenic rupture, splenic vein thrombosis and painful splenomegaly, to circumvent the splenic metastasis being a source of secondary meta- static disease, and to provide the potential for cure or extended survival. Since patients with splenic metastasis may be asymptomatic and the interval between the diagno- ses of endometrial carcinoma and splenic metastasis may be prolonged, careful and extended follow-up after primary treatment of endometrial carcinoma is warranted. Keywords Endometrial carcinoma · Imaging studies · Metastasis · Spleen · Splenecomy Introduction The spleen is an uncommon site of metastasis, with a fre- quency of 2.3–7.1% in large autopsy series of cancer patients, and with <100 cases in living cancer patients reported in the literature [1–3]. Several hypotheses have been suggested to explain the rarity of splenic metastasis [3–7]: 1. The constant blood Xow through the spleen impedes implantation of cancer cells in the spleen. 2. The sharp angle of the splenic artery branching from the celiac artery and the tortuosity of splenic artery make it diYcult for tumor emboli to enter the spleen. 3. The rhythmic contractions of the spleen squeeze tumor emboli from the spleen and prevent their implanting in the spleen. 4. The scarcity of aVerent lymphatic vessels in the spleen limits the transport of metastatic tumor cells into the spleen. B. Piura (&) · A. Rabinovich Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101 Beersheba, Israel e-mail: piura@bgu.ac.il L. Apel-Sarid · R. Shaco-Levy Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101 Beersheba, Israel