Kitamura Kei, Ogura Toshiro, Miyamoto Ryoichi, Ishida Hiroyuki, Matsudaira Shinichi, Takahashi Amane, Kanda Hiroaki, Fukuda Takashi
Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan.
Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan.
Surg Case Rep. 2023 Sep 20;9(1):167. doi: 10.1186/s40792-023-01753-1.
Tumor-associated sarcoid reactions have been observed with various tumors; however, they have not been reported with uterine cancer. We present two cases of splenic sarcoid reactions that mimicked metastases a few years after uterine cancer surgery.
Case 1 involved a 67-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent open total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Three years after the initial surgery, computed tomography (CT) and positron emission tomography CT showed multiple splenic masses with increasing numbers and sizes. Splenic metastases were diagnosed, and laparoscopic splenectomy was performed. The histopathological analysis revealed sarcoid reactions in the spleen. Case 2 involved a 47-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Two years after the initial surgery, multiple splenic masses were observed. We performed laparoscopic splenectomy for the splenic metastases. Granuloma formations were identified in the splenic specimen and perisplenic lymph nodes that were removed simultaneously, resulting in a final diagnosis of sarcoid reaction. A review of the lymph nodes at the time of the previous uterine surgery revealed granuloma formation. Other than the presence of splenic masses, no findings suggestive of recurrence were observed in these cases. Uterine cancer and sarcoid reactions progressed without recurrence after splenectomy.
To the best of our knowledge, this is the first report of the late development of splenic sarcoid reactions after uterine cancer surgery. Sarcoid reactions and metastases are difficult to diagnose based on preoperative imaging results. However, reviewing the specimen at the time of the initial resection, the number of lesions, and the clinical findings (other than imaging findings) may aid in the determination of the correct diagnosis.
已在多种肿瘤中观察到肿瘤相关的结节病反应；然而，子宫癌尚未见相关报道。我们报告两例子宫癌手术后数年出现类似转移的脾脏结节病反应病例。
病例1为一名67岁女性患者，诊断为子宫内膜癌（pT1aN0M0，p分期Ia期，1级）。患者接受了开放性全腹子宫切除术、双侧输卵管卵巢切除术及盆腔淋巴结清扫术。初次手术后三年，计算机断层扫描（CT）和正电子发射断层扫描CT显示脾脏有多个肿块，数量和大小不断增加。诊断为脾脏转移，遂行腹腔镜脾切除术。组织病理学分析显示脾脏有结节病反应。病例2为一名47岁女性患者，诊断为子宫内膜癌（pT1aN0M0，p分期Ia期，1级）。患者接受了腹腔镜全腹子宫切除术、双侧输卵管卵巢切除术及盆腔淋巴结清扫术。初次手术后两年，观察到脾脏有多个肿块。我们对脾脏转移灶进行了腹腔镜脾切除术。在同时切除的脾脏标本和脾周淋巴结中发现肉芽肿形成，最终诊断为结节病反应。回顾之前子宫手术时的淋巴结发现有肉芽肿形成。除脾脏有肿块外，这些病例未观察到提示复发的其他表现。脾切除术后子宫癌和结节病反应未复发而进展。
据我们所知，这是子宫癌手术后晚期出现脾脏结节病反应的首例报道。基于术前影像学结果，结节病反应和转移难以诊断。然而，在初次切除时复查标本、病变数量及临床发现（影像学发现以外）可能有助于确定正确诊断。
