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Yoshizawa J, Kubo N, Ishizone S, Karasawa F, Nakayama A. Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review. BMC Cancer 2017. [PMID: 28637437 PMCID: PMC5480154 DOI: 10.1186/s12885-017-3434-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Solitary metastasis of a malignancy to the spleen is rare, particularly for gastric cancer. Only a few case reports have documented isolated splenic metastasis from early gastric cancer. We describe a case of splenic metastasis from early gastric cancer. CASE PRESENTATION A 60-year-old man underwent a distal gastrectomy for early gastric cancer. It infiltrated the submucosa with pathological nodal involvement (pT1bN2M0, stage IIB). One year after the gastrectomy, an abdominal computed tomography scan showed a low-density lesion, 17 mm in diameter, at the upper pole of the spleen. Positron emission tomography/computed tomography showed focal accumulation of fluorine-18 fluorodeoxyglucose in the spleen without extrasplenic tumor dissemination or metastasis. We diagnosed splenic metastasis of gastric cancer, and performed a splenectomy. Histological examination confirmed moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma (solid type) that was consistent with the features of the primary gastric cancer. The splenic tumor was pathologically and immunohistochemically diagnosed as a metastasis from the gastric carcinoma. More than 18 months after the splenectomy, the patient has had no evidence of recurrent gastric cancer. CONCLUSION When solitary metastasis to the spleen is suspected during the postoperative follow-up of a patient with gastric cancer, a splenectomy is a potentially effective treatment.
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Affiliation(s)
- Junichi Yoshizawa
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano, Prefecture, 399-8695, Japan. .,Present address: Suwa Red Cross Hospital, 5-11-50 Kogandori, Suwa-shi, Nagano, Prefecture, 392-8510, Japan.
| | - Naoki Kubo
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano, Prefecture, 399-8695, Japan
| | - Satoshi Ishizone
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano, Prefecture, 399-8695, Japan
| | - Fumitoshi Karasawa
- Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano, Prefecture, 399-8695, Japan
| | - Ataru Nakayama
- Department of Surgery, Ina Central Hospital, 1313-1 Koshirokubo, Ina-shi, Nagano, Prefecture, 396-8555, Japan
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Avninder S, Bhatnagar A, Agrawal U, Saxena S. Isolated splenic metastasis from colorectal mucinous carcinoma. ACTA ACUST UNITED AC 2012; 37:98-101. [PMID: 17827530 DOI: 10.1007/s12029-007-0007-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 01/09/2023]
Abstract
Metastatic tumors of the spleen are rare and occur in the presence of disseminated visceral metastasis. Isolated splenic metastases from colorectal carcinoma are rare and only 19 cases have been reported in English literature. We report a case of isolated splenic metastasis in a 52-year-old man, occurring 9 years after the primary colorectal mucinous carcinoma was treated by anterior resection. The patient underwent splenectomy along with adjuvant chemotherapy and is alive and asymptomatic at 22 months follow-up.
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Affiliation(s)
- Singh Avninder
- Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi, 110029, India.
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Metastatic splenic α-fetoprotein-producing adenocarcinoma: Report of a case. Surg Today 2011; 41:854-8. [DOI: 10.1007/s00595-010-4336-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 03/09/2010] [Indexed: 10/18/2022]
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Isolated splenic metastasis from colorectal cancer. Int J Clin Oncol 2011; 16:306-13. [PMID: 21258837 DOI: 10.1007/s10147-010-0182-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/23/2010] [Indexed: 12/16/2022]
Abstract
Splenic metastases are unusual, arising in less than 1% of all metastases. Isolated solitary splenic metastasis from colorectal carcinoma is considered exceptional. This rarity has been explained by several hypotheses relating to the anatomical, histological, and immunological features of the spleen. We review the reported cases of isolated solitary splenic metastasis from colorectal carcinoma and discuss the diagnostic and therapeutic options for this entity. We searched the English-language medical literature, using the Medline and Pubmed databases from January 1966 through July 2010, for articles reporting isolated splenic metastasis from colorectal carcinoma. Only 26 cases have been reported; four cases had synchronous splenic metastasis. Fifteen patients had regional lymph node involvement on diagnosis of primary carcinoma. The primary tumor was located in the left colon or in the rectum in 18 cases. Carcinoembryonic antigen (CEA) level was elevated in 73% of cases. All patients underwent curative splenectomy; only one patient had laparoscopic resection of the spleen. Mean reported survival interval was 19.5 months; only three patients were deceased at last follow-up. Solitary splenic metastasis from colorectal carcinoma is very rare; clinicians are advised to pay close attention when routinely evaluating patients with serial CEA levels and abdominal scans. Splenectomy seems to be the preferred treatment modality with improvement of long-term survival. However, definitive conclusions cannot be drawn from the small number of case reports available.
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Sileri P, D'Ugo S, Benavoli D, Stolfi VM, Palmieri G, Mele A, Gaspari AL. Metachronous splenic metastasis from colonic carcinoma five years after surgery: a case report and literature review. South Med J 2009; 102:733-5. [PMID: 19487993 DOI: 10.1097/smj.0b013e3181a93c39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Metastatic lesions of the spleen are a rare finding and are generally associated with widespread disease. Moreover, solitary metastases of the spleen are exceptional. In this paper, we describe the case of a patient who developed an isolated splenic metastasis from colon carcinoma five years after surgery, and was successfully treated by splenectomy. We also review the scant literature experience discussing clinical diagnosis and approaches to this uncommon event.
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Affiliation(s)
- Pierpaolo Sileri
- From the Departments of Surgery and Pathology, University of Rome Tor Vergata, Rome, Italy
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Clinical case report and literature review: metachronous colorectal splenic metastases. Clin Transl Oncol 2008; 10:445-7. [PMID: 18628076 DOI: 10.1007/s12094-008-0230-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies.
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Montemurro S, Maselli E, Ruggieri E, Caliandro C, Rucci A, Zito AF, Sciscio V. Isolated splenic metastasis from colon cancer. Report of a case. TUMORI JOURNAL 2008; 94:422-5. [PMID: 18705414 DOI: 10.1177/030089160809400322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Isolated splenic metastasis is an uncommon event, except in the case of secondary involvement by lymphoma. The most common sites of metastases of colorectal cancer are the regional lymph nodes, liver and peritoneum; lung and bone are rarely involved, the spleen exceptionally. In this paper we report a case of metachronous isolated splenic metastasis of transverse colon cancer in an 80-year-old woman who was successfully treated by splenectomy. The peculiar clinical-pathological aspects of this kind of metastasis are discussed on the basis of our clinical observation and a review is presented of similar cases reported in the literature. Only 14 reported cases of isolated splenic metastasis from colorectal cancer were found in Medline.
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Affiliation(s)
- Severino Montemurro
- Department of Surgical Oncology, National Cancer Institute Giovanni Paolo II, Bari, Italy.
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Pisanu A, Ravarino A, Nieddu R, Uccheddu A. Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: A case report and review of the literature. World J Gastroenterol 2007; 13:5516-20. [PMID: 17907299 PMCID: PMC4171290 DOI: 10.3748/wjg.v13.i41.5516] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.
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Affiliation(s)
- Adolfo Pisanu
- Clinica Chirurgica, Università degli Studi di Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, Cagliari 09124, Italy.
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Gencosmanoglu R, Aker F, Kir G, Tozun N. Isolated metachronous splenic metastasis from synchronous colon cancer. World J Surg Oncol 2006; 4:42. [PMID: 16824207 PMCID: PMC1526733 DOI: 10.1186/1477-7819-4-42] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 07/06/2006] [Indexed: 11/10/2022] Open
Abstract
Background Isolated splenic metastases from colorectal cancer are very rare and there are only 13 cases reported in the English literature so far. Most cases are asymptomatic and the diagnosis is usually made by imaging studies during the evaluation of rising CEA level postoperatively. Case presentation A 76-year-old man underwent an extended left hemicolectomy for synchronous colon cancers located at the left flexure and the sigmoid colon. The tumors were staged as IIIC (T3N2M0) clinically and the patient received adjuvant chemotherapy. During the first year follow-up period, the patient remained asymptomatic with normal levels of laboratory tests including CEA measurement. However, a gradually rising CEA level after the 14th postoperative month necessitated further imaging studies including computed tomography of the abdomen which revealed a mass in the spleen that was subsequently confirmed by 18FDG- PET scanning to be an isolated metastasis. The patient underwent splenectomy 17 months after his previous cancer surgery. Histological diagnosis confirmed a metastatic adenocarcinoma with no capsule invasion. After an uneventful postoperative period, the patient has been symptom-free during the one-year of follow-up with normal blood CEA levels, although he did not accept to receive any further adjuvant therapy. To the best of our knowledge, this 14th case of isolated splenic metastasis from colorectal carcinoma is also the first reported case of splenic metastasis demonstrated preoperatively by 18FDG PET-CT fusion scanning which revealed its solitary nature as well. Conclusion Isolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy.
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Affiliation(s)
- Rasim Gencosmanoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
- Unit of Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | - Fugen Aker
- Department of Pathology, Haydarpasa State Hospital, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Umraniye State Hospital, Istanbul, Turkey
| | - Nurdan Tozun
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Abstract
Solitary splenic lesion is a rare presentation of a previous or current malignancy. We describe a case of an isolated splenic lesion caused by endometrial carcinoma and summarize all the published reports on solitary splenic metastasis.
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Affiliation(s)
- S Agha-Mohammadi
- Department of Surgery, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
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Massarweh S, Dhingra H. Unusual sites of malignancy: case 3. Solitary splenic metastasis in lung cancer with spontaneous rupture. J Clin Oncol 2001; 19:1574-5. [PMID: 11230502 DOI: 10.1200/jco.2001.19.5.1574] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- S Massarweh
- Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
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Verger P, Weinfeld C, Henni Z, Henni T, Blais J, Garnier PP. [Hemoperitonitis revealing an isolated splenic metastasis secondarily attributed to a caecal adenocarcinoma]. Rev Med Interne 2000; 21:463. [PMID: 10874769 DOI: 10.1016/s0248-8663(00)88960-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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