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LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 3  |  Page : 200-201  

Recurrent carcinoma cervix presenting as metastatic splenomegaly: 18F-FDG PET/CT findings in a rare scenario


Department of Nuclear Medicine and Positron Emission Tomography/Computerized Tomography, Eastern Diagnostics India Ltd., Kolkata, West Bengal, India

Date of Web Publication11-Jul-2014

Correspondence Address:
Punit Sharma
Department of Nuclear Medicine and Positron Emission Tomography/Computerized Tomography, Eastern Diagnostics India Ltd, 13C, Mirza Ghalib Street, Kolkata - 700 016, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.136608

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How to cite this article:
Sharma P, Chatterjee P, Mazumdar B. Recurrent carcinoma cervix presenting as metastatic splenomegaly: 18F-FDG PET/CT findings in a rare scenario. Indian J Nucl Med 2014;29:200-1

How to cite this URL:
Sharma P, Chatterjee P, Mazumdar B. Recurrent carcinoma cervix presenting as metastatic splenomegaly: 18F-FDG PET/CT findings in a rare scenario. Indian J Nucl Med [serial online] 2014 [cited 2020 Feb 25];29:200-1. Available from: http://www.ijnm.in/text.asp?2014/29/3/200/136608

Sir,

Cervical cancer is the leading gynecological cancer in India. [1] Nodes are the commonest site of metastasis followed by lungs. [2] Splenic metastasis from cervical cancer is very rare. [3] We present such a case where recurrent carcinoma cervix presented as metastatic splenomegaly. A 52-year-old lady diagnosed to have carcinoma cervix stage IIIB had undergone radical hysterectomy followed by pelvic radiotherapy. She was on routine follow up. Three-years later she presented with pain and heaviness in left hypochondrium. Physical examination revealed massive splenomegaly. Pelvic examination was within normal limits. She underwent contrast-enhanced 18 F-fluorodeoxyglucose ( 18 F-FDG) whole body positron emission tomography/computed tomography (PET/CT) because of suspicion of metastasis. PET/CT revealed heterogeneously enhancing 18 F-FDG avid splenomegaly [Figure 1]a, e-g. In addition, metastasis was also noted in the pancreas [Figure 1]a, h-j] and left supraclavicular node [Figure 1]a, k-m. No local recurrence or any abdominopelvic nodal metastasis was seen [Figure 1]a-d. Because splenic metastasis from carcinoma cervix is very rare, fine-needle aspiration cytology (FNAC) was performed from the splenic mass. FNAC revealed metastatic squamous cell carcinoma. She was started on chemotherapy (carboplatin and paclitaxel) but died of progressive disease 4-months later.
Figure 1: Maximum intensity projection PET image (a) showing abnormal 18F-FDG accumulation in left hypochondrium (arrows), mid abdomen (broken arrow), and left lower neck (arrowhead). No local recurrent disease was seen (b-d). Axial contrast CT (e), PET (f), and PET/CT (g) images reveal massive solid cystic splenomegaly (arrows) with heterogeneous enhancement and irregularly increased 18F-FDG uptake (SUVmax-7.9). The splenic lesion is also infiltrating the tail of pancreas. Another enhancing 18F-FDG avid (SUVmax-4.1) mass at junction of head and body of pancreas (h-j, broken arrow) was seen. Also noted was enlarged 18F-FDG avid (SUVmax-3.1) left supraclavicular lymphadenopathy (k-m, arrowhead) PET = positron emission tomography, 18F-FDG = 18F-fluorodeoxyglucose, CT = Computed tomography, SUV = Standardized uptake value.

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Splenic metastasis from carcinoma cervix is extremely rare. [4] Less than 100 cases of solitary splenic metastases have been reported with half of them being metastases from the female genital tract malignancies: 30 ovarian carcinoma, 11 endometrial carcinoma, eight cervical carcinoma, and one tubal carcinoma. [3] Goktolga et al., [4] reported a case of a 45-year-old lady, postoperative case of carcinoma cervix who presented with splenic metastasis. Pang et al., [5] reported a case of recurrent carcinoma cervix presenting with splenic metastasis and successfully treated with laparoscopic splenectomy and chemotherapy. Campagnutta et al., [6] also reported isolated splenic metastasis in a postoperative patient of carcinoma cervix. Splenic metastasis can rarely present as painful splenomegaly [7] as in the present case. To the best of our knowledge, there is no published report showing 18 F-FDG PET/CT findings in metastatic splenomegaly from cervical cancer. In the present case, 18 F-FDG PET/CT confirmed the suspicion of metastasis to spleen, a rare site. In addition, it demonstrated previously unknown metastasis to pancreas and supraclavicular node. The current case further highlights the importance of 18 F-FDG PET/CT in restaging of cervical cancer.

 
   References Top

1.Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res 2009;130:219-21.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Long HJ 3 rd . Management of metastatic cervical cancer: Review of the literature. J Clin Oncol 2007;25:2966-74.  Back to cited text no. 2
    
3.Piura E, Piura B. Splenic metastases from female genital tract malignancies. Harefuah 2010;149:315-20, 335, 334.  Back to cited text no. 3
    
4.Goktolga U, Dede M, Deveci G, Yenen MC, Deveci MS, Dilek S. Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: A case report and review of the literature. Eur J Gynaecol Oncol 2004;25:742-4.  Back to cited text no. 4
    
5.Pang LC. Solitary recurrent metastasis of squamous cell carcinoma of the uterine cervix in the spleen: Case report. South Med J 2004;97:301-4.  Back to cited text no. 5
    
6.Campagnutta E, Zarrelli A, Stefanutti V, Cimitan M, Querin F, Scarabelli C. Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case. Minerva Ginecol 1992;44:667-70.  Back to cited text no. 6
    
7.Klein B, Stein M, Kuten A, Steiner M, Barshalom D, Robinson E, et al. Splenomegaly and solitary spleen metastasis in solid tumors. Cancer 1987;60:100-2.  Back to cited text no. 7
    


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