Abstract
BackgroundIsolated 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 presentationA 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.ConclusionIsolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy.
Highlights
Isolated splenic metastases from colorectal cancer are very rare and there are only 13 cases reported in the English literature so far
Isolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy
Histopathologic examination of the splenectomy specimen showed that the tumor within the spleen was a metastasis of a moderately differentiated adenocarcinoma with 5 × 6 × 6.5 cm in dimensions and it was sharply demarcated from the adjacent splenic parenchyma without any capsule invasion (Figure 4A)
Summary
Splenic metastases from colorectal carcinoma are very rare and usually occur as a component of disseminated disease. Histopathologic examination of the splenectomy specimen showed that the tumor within the spleen was a metastasis of a moderately differentiated adenocarcinoma with 5 × 6 × 6.5 cm in dimensions and it was sharply demarcated from the adjacent splenic parenchyma without any capsule invasion (Figure 4A). Because the patient had a previous colon cancer surgery and no findings of any primary tumor (i.e. adenocarcinoma) in any other organ except metastatic splenic tumor at laparotomy as well as on the preoperative CT and PET scanning besides the decrease of the high blood CEA level to within normal limits following splenectomy and the presence of histologic similarities between the metastatic tumor and the primaries, the present case was accepted as a solitary metachronous splenic metastasis from colon cancer. The patient has been symptom-free during the oneyear of follow-up with a normal blood CEA levels, he did not accept to receive any further adjuvant therapy
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