Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):79-82. 10.14701/ahbps.2018.22.1.79.

Laparoscopic splenectomy for splenic rupture secondary to metastatic choriocarcinoma

Affiliations
  • 1Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. aloysius.tan@mohh.com.sg

Abstract

Gestational choriocarcinoma is a rare and aggressive type of gestational trophoblastic neoplasia, which is characterized by early vascular invasion and widespread metastases. Choriocarcinoma metastasizes hematogenously, and bleeding from metastases is common. Splenic rupture from a metastatic tumour is exceedingly rare, with only a few reports. We report a case of a 41-year-old female presenting with acute abdomen and haemorrhagic shock secondary to splenic rupture from metastatic choriocarcinoma, which was managed with emergency laparoscopic splenectomy.

Keyword

Choriocarcinoma; Laparoscopy; Splenic rupture

MeSH Terms

Abdomen, Acute
Adult
Choriocarcinoma*
Emergencies
Female
Gestational Trophoblastic Disease
Hemorrhage
Humans
Laparoscopy
Neoplasm Metastasis
Pregnancy
Shock
Splenectomy*
Splenic Rupture*

Figure

  • Fig. 1 Splenectomy specimen showing splenic metastases with blood clot.

  • Fig. 2 Medium power view showing spleen affected by syncytiotrophoblasts and cytotrophoblasts suggestive of metastatic choriocarcinoma (Haematoxylin and Eosin stain, original magnification ×100).

  • Fig. 3 Endoscopic image showing duodenal lesion with intra luminal bleeding.


Reference

1. Yürüyen M, Yildiz O, Papila C, Tuzuner N. Gestational choriocarcinoma diagnosed with spontaneous splenic rupture after pregnancy induced by in vitro fertilization: a case report. Cases J. 2009; 2:7518.
Article
2. Galazi M, Tait P, Seckl M, Savage P. Successful embolization of a life threatening bleeding splenic metastasis in a patient with gestational choriocarcinoma. Clin Obstet Gynecol Reprod Med. 2015; 1:16–18.
3. Lam KY, Tang V. Metastatic tumors to the spleen: a 25-year clinicopathologic study. Arch Pathol Lab Med. 2000; 124:526–530.
4. Challis DE, Rew KJ, Steigrad SJ. Choriocarcinoma complicated by splenic rupture: an unusual presentation. J Obstet Gynaecol Res. 1996; 22:395–400.
Article
5. Nethra S, Hawe J, Elder J. Splenic rupture: a rare presentation of metastatic choriocarcinoma. Gynecol Surg. 2011; 8:435–437.
Article
6. Ghinescu C, Sallami Z, Jackson D. Choriocarcinoma of the spleen--a rare cause of atraumatic rupture. Ann R Coll Surg Engl. 2008; 90:W12–W14.
7. Shelat VG, Tan EK, Teo LT, Vijayan A, Chiu MT. Outcomes of non-operative management of blunt splenic injury - An Asian experience. Int Surg. 2015; 100:1281–1286.
8. Musallam KM, Khalife M, Sfeir PM, Faraj W, Safadi B, Abi Saad GS, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013; 257:1116–1123.
Article
9. Shelat VG, Chan CY, Liau KH, Ho CK. Laparoscopic exploration can salvage failed endoscopic bile duct stone extraction. Singapore Med J. 2012; 53:313–317.
10. Shelat VG, Serin K, Samim M, Besselink MG, Al Saati H, Gioia PD, et al. Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg. 2014; 38:3175–3180.
Article
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr