Metachronous Isolated Splenic Metastasis From Cervical Squamous Cell Carcinoma Directly Invading the Stomach: A Case Report

The spleen is a very rare location for isolated blood-borne metastasis from squamous cell carcinoma of the uterine cervix (cSCC), thus splenic metastases from cSCC are associated with diagnostic and therapeutic challenges. We present a case of a 47-year-old woman with a history of International Federation of Gynecology and Obstetrics (FIGO) stage IIIc, human papillomavirus (HPV)-associated cSCC who presented with an isolated splenic metastasis eight months after completing primary treatment. The patient presented to the emergency department with symptomatic anemia. A CT scan of the abdomen showed a large splenic mass measuring 6.8 x 6.8 cm that appeared to directly invade the fundus of the stomach; a subsequent gastroscopy revealed an ulcerated, oozing lesion, which was biopsied and confirmed to be SCC. Following a multidisciplinary tumor board discussion, given the inability to obtain endoscopic hemostasis, the patient underwent expedited splenectomy, distal pancreatectomy, longitudinal gastrectomy, and pyloroplasty. Histological examination showed a high-grade, HPV-associated cSCC, consistent with metastatic spread from the known primary cervical cancer. The patient was initiated on cisplatin, paclitaxel, and pembrolizumab and received four cycles before experiencing disease progression.