Isolated Splenic Metastasis and Splenic Bed Recurrence From Endometrial Carcinoma: A Rare Case

Papillary serous carcinoma is a rare and aggressive subtype of endometrial cancer with a strong predilection for extrauterine spread. Although metastasis typically involves the peritoneum, lymph nodes, and lungs, isolated splenic metastases are exceedingly rare. We report the case of a 66-year-old woman initially diagnosed with papillary serous endometrial carcinoma following an episode of postmenopausal bleeding. She underwent surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy, followed by adjuvant chemotherapy. Two years later, she presented with non-specific abdominal discomfort, and imaging revealed a solitary splenic lesion. A splenectomy was performed, and histopathology confirmed metastatic papillary serous carcinoma. The patient remained stable until a further year later when she was re-presented with fatigue and left upper quadrant pain. Imaging demonstrated a soft tissue mass in the splenic bed, and histopathological analysis confirmed the recurrence of the known malignancy. This case underscores the potential for late, isolated splenic metastasis and recurrence in the splenic bed after splenectomy which is exceptionally uncommon. It highlights the importance of long-term surveillance and the consideration of atypical metastatic patterns in patients with serous endometrial cancer. This report adds to the limited literature and reinforces the value of individualized, multidisciplinary management in such complex clinical scenarios.