Spontaneous Rupture of the Spleen Secondary to Metastatic Teratoma

A man aged 30 years presented as an emergency with a short history of testicular swelling and vague abdominal pain. Tumour markers were checked; «-fetoprotein was 2900 kU/L and beta-hCG was 212000 lUlL. Orchidectomy confirmed the diagnosis of malignant teratoma (choriocarcinoma). Computerized tomography (CT) of the abdomen was reported as showing enlarged para-aortic nodes and a large splenic mass with ascites (Figure 1). Post-operatively it was noted that his haemoglobin had dropped from 13g/dL to 7.2g/dL. He became more unwell with generalizld abdominal pain, tachycardia and mild pyrexia. On examination his abdomen was tender with shifting dullness. Review of the CT scan suggested a subcapsular splenic haematoma. At laparotomy he was found to have a ruptured spleen with a large amount of free blood. The spleen was removed. Enlarged para-aortic nodes were observed but there was no other evidence of intra-abdominal disease. Histology confirmed extensive splenic metastases with the same histology as the testis. The patient made a good post-operative recovery. He was treated with six cyclesof cisplatin, bleomycinand etoposide and his tumour markers fellto normal. Four months later he relapsed with lungandbrain metastasesand a {j-hCG of over 106 lUlL. He responded well to chemotherapy with paclitaxel, ifosfamide and cisplatin, but after three cycleshe refused further treatment. He subsequently deteriorated rapidly and died.