Case Of Splenic Metastasis Research Articles

Splenic metastasis from recurrent chromophobe renal cell carcinoma 12\xa0years post-nephrectomy: a case report

BackgroundRenal cell carcinoma metastases to the spleen are rare. At the time of this report, only 20 cases of splenic metastases from RCC have been published in the literature. To our knowledge, our report is the first splenic metastasis from a chromophobe RCC.Case presentationA 44-year-old woman presented with clinical and radiological features of splenic metastasis from RCC, 12 years after radical nephrectomy for chromophobe RCC. Computed tomography, laparotomy and splenectomy revealed metastases to the spleen and retroperitoneal lymph nodes.ConclusionSplenic metastasis from RCC is uncommon, and rarer still from a chromophobe subtype of RCC. Surgical management of the metastasis is recommended.

ISOLATED SPLENIC METASTASIS IN A PATIENT WITH ESTHESIONEUROBLASTOMA

Esthesioneuroblastoma is included in the group of rare malignant neuroectodermal tumors. Since 1924 up to the present, around 1,000 cases of this tumor have been detected worldwide, with only one case of splenic metastasis in a patient with esthesioneuroblastoma described. We present yet another clinical observation of splenic metastasis in a patient with esthesioneuroblastoma (nasal cavity tumor).

Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review

BackgroundSolitary 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 presentationA 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.ConclusionWhen 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.

A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised and an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

肝細胞癌術後脾転移の1切除例

肝細胞癌術後脾転移の1切除例

Cytologically Confirmed Splenic Metastases in Breast Cancer

Relatively few cases of splenic metastases have been reported in the literature. Metastases to the spleen generally occur in the context of multivisceral involvement during the late stage of disease, while isolated splenic metastases are far less frequent. The primary cancer types commonly leading to splenic metastases are skin melanoma and gynecologic, colorectal and gastric cancers. Breast cancer is considered a rare source of splenic metastases, with few cases being reported in the literature. As a contribution to the literature, we report here on a case of splenic metastasis in a patient with breast cancer treated at the Department of Medical Oncology at our institution (Bellaria-Maggiore Hospital, Azienda USL of Bologna, Italy).

Solitary splenic metastasis from early gastric cancer: Report of a case

Solitary metastasis of a malignancy to the spleen is rare. We herein describe a case of splenic metastasis from early gastric cancer. A 76-year-old man underwent an endoscopic mucosal resection (EMR) for early gastric carcinoma in the cardia. Pathologically, the tumor showed invasion into the submucosal layer, and the stump of the surgical specimen appeared to be positive for malignant cells. He thus underwent a proximal gastrectomy with nodal dissection. One year later, serum carcinoembryonic antigen was elevated, and a splenic mass was detected by computed tomography and ultrasonography. Because the tumor increased in size very gradually and no metastatic lesions were detected at the other sites, we performed a splenectomy. The lesion was pathologically diagnosed as metastasis from the previous gastric carcinoma, and the patient remains healthy to date without recurrence, more than 2 years after the splenectomy. 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.

SOLITARY SPLENIC METASTASIS FROM COLON CARCINOMA-REPORT OF TWO CASES-

Two cases of splenic metastasis from colon carcinoma without other organ metastasis are reported. Patient 1 was a 76-year-old man, who underwent a right hemicolectomy for ascending colon carmcinoma. Twenty two months later, a splenectomy and partial resection of the pancreas were performed for solitary metastasis to the spleen. He was alive with local recurrence 25 months after the second operation. Patient 2 was a 74-year-old man, who underwent a right hemicolectomy for ascending colon carcinoma. One year later, a splenectomy and caudal pancreatectomy was performed for solitary splenic metastasis from the ascending colon carcinoma. He was alive with no evidence of recurrence 5 months after the second operation. In both patient 1 and 2, the histological diagnoses of both the colon and splenic tumors were the same. Splenic metastasis after a colorectal carcinoma operation is rare. Only 30 cases including ours have been reported in Japan. Most splenic metastases occurred within 1 year after the colorectal operation, and prognosis was poor. Micrometastasis to the spleen might have already occurred at the time of operation for colorectal carcinoma, therefore, intensive chemotherapy after operation is recommended for splenic metastasis from colorectal carcinoma.

Three-dimensional power Doppler sonography of tumor vascularity.

The purpose of this study was to assess the value of routine clinical examination using three-dimensional power Doppler sonography of intratumoral blood flow. Twenty-two hepatocellular carcinomas, seven cases of hepatic metastasis, four hepatic hemangiomas, six renal cell carcinomas, two cases of hepatic focal nodular hyperplasia, and one case of splenic metastasis were included in the study. Three-dimensional images were reconstructed by maximum intensity projection method using cine-loop data on a built-in computer in a LOGIQ 500 and a LOGIQ 700 from GE Yokogawa Medical Systems. The three-dimensional images obtained were viewed multidirectionally on a monitor screen. Three-dimensional representations of intratumoral blood flow became available for all tumors approximately 5 s to 30 s after scanning. In every case, the entire vasculature of the tumor was appreciated more easily from three-dimensional images than from cross-sectional two-dimensional images. These three-dimensional images of intratumoral blood flows corresponded to the tumor vessels that could be visualized by angiography at the early arterial phase. Differential diagnosis of hepatic tumors based on distinct difference in their intratumoral vascular structures was performed. Our results suggest that three-dimensional power Doppler sonography can be used for routine clinical examination of tumor vascularity and may provide improved diagnostic information.

Splenic metastasis from lung cancer

Splenic metastasis from lung cancer is a rare clinical event, most often diagnosed at the time of autopsy. We report 2 cases of splenic metastasis with a primary lung cancer. The first case was a 76-year-old man presenting with a recurrent solitary splenic metastasis 14 months after surgical removal of a squamous cell carcinoma of the lung. The second patient was a 72-year-old woman who had a poorly differentiated carcinoma of the lung and multiple abdominal metastasis. We also investigated 267 autopsy cases of lung cancer from 1975 to 1992. Histologically, there were 73 cases of squamous cell carcinoma, 123 adenocarcinoma, 29 large cell carcinoma, 36 small cell carcinoma, and 7 other miscellaneous tumours. The number of splenic metastasis from lung cancer in these cases was 15 (5.6%). Splenic metastasis from a primary cancer of the left lung was more frequent than that from the right lung. Nine of 15 splenic metastases were smaller than 1 cm in size. Splenic metastasis was associated with liver and pancreas metastasis. All 15 autopsy cases with splenic metastasis from lung cancer had other abdominal organ metastasis. Our analysis indicates that a solitary splenic metastasis is rare. Selection of a suitable therapeutic approach is important.

大腸癌ひ転移の切除例 本邦報告１９例の集計

結腸癌術後の稀と考えられる脾転移再発の2切除例を経験したので報告する. 症例1は69歳の女性で, 上行結腸癌切除術の2年7カ月後にCEAの上昇をきたし, 腹部CT検査にて脾転移再発を認め, 脾臓, 肝転移巣を切除し, 脾門・脾動脈リンパ節に転移を認めた. 症例2は75歳の女性で, S状結腸癌と盲腸癌の異時性多発癌で盲腸癌切除の6カ月後にCEAの上昇をきたし, 腹部CT検査で脾転移再発を認め, 脾摘除術を施行した. 症例1は1年2カ月後に肝転移巣の増悪により原癌死したが, 症例2は9カ月無再発生存中である. 大腸癌における脾転移は文献上19例が報告されており, 多くが血行性の転移と考えられている. 脾転移再発では全例CEA高値を認め, CEAの有用性が示唆された. また孤立性の脾転移は切除により予後の改善が期待できるが, ほかの血行性転移に対する経過観察が必要と考えられる.

A CASE OF SURGICAL TREATMENT OF SOLITARY SPLENIC METASTASIS AFTER A CURATIVE RESECTION OF EARLY GASTRIC CANCER

This paper describes a case of solitary splenic metastasis 2 years and 9 months after curative resection of an early gastric cancer, which was treated by splenectomy.A 63-year-old man was seen at the hospital because of a fever and left abdominal pain. Ultrasonography, computed tomography and angiography, splenic abscess and splenic tumor revealed. Splenectomy was performed. No hepatic metastasis, lymph node metastasis or peritoneal dissemination was observed. The surgical specimen exhibited a tumor in a size of 5×4.5 cm in the splenic parenchyma, and histopathological findings proved the lesion to be well differentiated adenocarcinoma. The histopathological image closely resemmbled that of the early gastic cancer excised 2 years and 9 months before. It was diagnosed as metastasis of the gastric cancer into the spleen. Splenic metastasis can be seen at times in a state associated with multiple metastatic lesions in terminal cancers, but solitary splenic metastasis is rare. Particularly the splenic lesion metastasized from gastrointestinal cancer for which splenectomy was successfully performed is so rare that only 12 cases have been reported in Japan as far as we can review. Among the 12 cases no other case of splenic metastasis from an early cancer can not be seen.

Intrasplenic metastases from carcinoma of the ovary

Intrasplenic metastases are an uncommon manifestation of malignant disease. The relative paucity of splenic metastases is thought to be due to the properties of the spleen as an organ of immune surveillance. We report five cases of splenic metastases from carcinoma of the ovary demonstrated by CT scanning and ultrasound examination. In this series, splenic metastases were associated with bulk disease and more anaplastic tumours. Increased availability of magnetic resonance imaging may improve the recognition of splenic metastases.

Primary Liver Cell Carcinoma with Splenic Metastases

Primary liver-cell carcinoma is frequent among Malays and Mongols but relatively unusual in European races (Bonne). In Europe and the United States primary carcinoma of the liver, including both liver-cell and duct-cell types, is found in from 0.1 to 0.14 per cent of all necropsies (Herxheimer). Metastasis of carcinoma to the spleen is also generally considered to be of rare occurrence, though an accurate estimate of its frequency is difficult. Thus Yokohata found 6 cases of splenic metastases in a series of 29 carcinomas, Kurosu found 5 instances among 54 carcinomas, and Deelman 7 among 75. When, however, large numbers of unselected cases of carcinoma are systematically studied, the proportion of splenic metastases is found to be much smaller. Di Biasi encountered 50 examples in his own series of 2,422 cases (2.1 per cent) and 182 in 9,761 cases collected from other sources (1.9 per cent); Monti found splenic metastases in 28 of 649 cases of carcinoma and sarcoma; Warren and Hobson in 46 of 1,140 cases of carcinoma and sarcoma (4 per cent). Account must also be taken of differences in the morphologic criteria of splenic metastases. Those who find such metastases numerous generally include in their figures every case, without restriction, in which the presence of one or more cancer cells can be demonstrated in the spleen, even though these are free in the sinuses or blood vessels or occur only within the capsule. According to Krumbhaar and Scott, “cells in the blood stream do not constitute metastatic growth … tumor cells can be injected into or found in the circulation without necessarily causing tumor growth.” Braunstein pointed out that of Yokohata9s 6 cases only 2 were true splenic metastases, the others being either tumor emboli or growths in the capsule.