False or Unexpected Suspicion of Splenic Metastases in a Case of Stage IC1 Ovarian Carcinoma

Introduction Ovarian carcinoma is a significant cause of gynecologic cancer mortality, often requiring extensive surgical and systemic treatment. Rare diagnostic dilemmas, such as splenic lesions mimicking metastasis, underscore the importance of histological confirmation to guide treatment strategies. Case Presentation A 37-year-old woman presented with a right ovarian mass detected during routine ultrasound. Elevated CA-125 levels (37.97 U/mL) and CT with and without contrast showed low-density mass with contrast-enhancing septa, that suggested malignancy. Laparoscopic right salpingo-oophorectomy revealed endometrioid carcinoma (G1, pT1a Nx Mx). Comprehensive staging surgery, including total hysterectomy, omentectomy, and pelvic lymphadenectomy, confirmed Stage IC1 disease (pT1c1 N0 M0 G1). The patient underwent four cycles of carboplatin-based chemotherapy, achieving remission. Eighteen months later, recurrence was suspected due to imaging findings near the left iliac vessels and a splenic lesion, that increased in size overtime according to the CT scan results compared to the first CT scan. Cytoreductive surgery, including splenectomy, was performed. Surprisingly, postoperative histology revealed that the splenic lesion was benign lymphangiomas rather than metastasis. Discussion This case illustrates the complexity of managing ovarian carcinoma, emphasizing the importance of histopathological analysis in guiding treatment. While imaging and clinical findings strongly suggested splenic metastasis, histology revealed a benign condition, preventing overtreatment and altering the patient’s prognosis. Conclusions This case underscores the critical role of surgical staging, individualized treatment, and histological confirmation in ovarian carcinoma management. Vigilance in evaluating suspicious findings can help avoid unnecessary interventions and refine therapeutic approaches.