Splenic Metastasis Research Articles

乳癌術後脾転移の1例

再発乳癌の転移は骨，肺，あるいは肝臓に好発し，脾転移はまれである．臨床的に脾転移が指摘される場合，多臓器に転移が指摘される．われわれは，乳癌術後に孤立性脾腫瘍を発見し，診断治療目的に脾切除を行い，乳癌の脾転移と判明した1例を経験したので報告する．症例は68歳女性．2005年8月，左乳癌T1N0M0，Stage Iで左乳房部分切除術と腋窩リンパ節郭清術を施行した．術後5年4カ月の血液検査でCA15-3が基準値を超え始めたが，画像検査で積極的に再発を疑う病変を認めなかった．腫瘍マーカーは徐々に増加し，精査のFDG PET/CT検査で脾臓に異常集積を伴う充実性腫瘤が指摘された．孤立性脾腫瘍の原発性悪性腫瘍は非常にまれで，本症例では脾転移が疑われた．乳癌の孤立性脾転移は極めて珍しいため，診断治療目的に脾摘出術を施行した．脾転移の診断で化学療法を行ったが，術後7カ月で腹膜再発を認めた．

同時性孤立性脾転移をきたした上行結腸癌の1例

大腸癌の転移で孤立性脾転移はまれであり，同時性に孤立性脾転移を認めた上行結腸癌の症例を経験したので報告する．症例は80歳，男性．腸閉塞および右上腹部腫瘤の精査加療目的で紹介受診となった．大腸内視鏡検査で上行結腸に全周性の3型腫瘍を認め，生検で中分化腺癌と診断された．腹部CT検査では脾臓に55mm大の不均一に造影される腫瘍を認め，超音波検査でも同様に脾臓に内部不均一な腫瘍を認めた．以上より，上行結腸癌，脾腫瘍の診断で2010年7月に結腸右半切除術（D3郭清）・脾臓摘出術を施行した．上行結腸癌の病理組織検査は中分化腺癌が主体で脾腫瘍も同様の組織型であり，結腸癌の脾転移と診断された．術後経過は良好で，術後36ヵ月経過した現在も再発なく外来通院中である．

Metastatic involvement of the spleen by endometrial adenocarcioma; a rare asylum for a common malignancy: a case report

BackgroundMetastatic involvement of the spleen by solid tumors is a rare clinical entity; those coming from endometrial adenocarcinomas are exceptionally rare. Spleen is an uncommon site for metastatic deposits due to its specific anatomy and microenvironment. Typically, splenic metastasis from endometrial carcinomas present months to years after curative surgery, chemotherapy or radiotherapy. The most common complaint in symptomatic patients is abdominal pain localized to the left hypochondrium. Most however, are asymptomatic only to be picked up on vigilant routine ultrasonography or computerized tomography during follow up. We report the case of a 54-year-old woman who presented to us after 50 months of total abdominal hysterectomy and bilateral salpingo-oophorectomy for an endometrial adenocarcinoma. She had severe abdominal pain localized to the left hypochondrium as the presenting complaint. To the best of our knowledge, this is the 1st case to be reported from Pakistan with 14 cases reported prior to our report. All past cases report the endometroid variant of endometrial adenocarcinoma as the primary tumor and our patient was a victim to the same variant.Case presentationA 54-year-old, nulliparous widowed woman presented with severe abdominal pain in the left hypochondrium for the last 4 months. The pain radiated to the left shoulder and was exacerbated with deep breathing. She had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy done 50 months back for stage 1a endometroid endometrial adenocarcinoma. Clinical examination revealed tenderness in the left hypochondrium but no visceromeglay was appreciable. Ultrasonography and computerized tomography revealed a space-occupying lesion within the spleen with associated splenomegaly. Computed tomography further suggested a large splenic abscess however the patient did not have fever, vomiting or leukocytosis which are the hallmarks of a splenic abscess. A splenectomy was performed for her complaints. On histopathology a metastatic adenocarcinoma was identified consistent with the primary tumor. The tumor was CK7, CA-125 and epithelial membrane antigen positive (EMA). The patient was then referred for further chemotherapy.ConclusionFrom this case we conclude, that although very rare, the spleen is a potential site for metastasis in endometroid endometrial adenocarcinoma. Since most patients are asymptomatic, routine examinations and imaging can identify its presence and avoid complications. If the practice is employed with vigilance, we may expect the clinical event to be diagnosed more frequently. The standard treatment is a classic splenectomy followed by chemotherapy.

Postoperative isolated splenic metastasis from gallbladder cancer: report of a case

We present a rare case of metachronous splenic metastasis from gallbladder cancer. A 65-year-old female with gallbladder cancer underwent a partial hepatectomy with en-bloc resection of the gallbladder and extrahepatic bile duct. Ten months later, she presented with isolated splenic metastasis and underwent splenectomy with distal pancreatectomy. The histological diagnosis confirmed metastatic adenocarcinoma from gallbladder cancer. She had no signs of recurrence 4years after the second surgery. To the best of our knowledge, this is the first report of isolated splenic metastasis from gallbladder cancer.

Laparoscopic thermal ablation of splenic metastases initial experience and present aspects

Splenic metastases develop in less than 1% of all metastatic cancers, and typically occur in a setting of disseminated disease. When isolated splenic metastasis occurs, the patient may be a candidate for aggressive treatment consisting mainly of splenectomy as described in the literature. However, the increased incidence of post-operative morbidity and severe infection after splenectomy are well known. We report a case of splenic metastasis that developed from colorectal cancer and was treated by laparoscopic-guided radiofrequency ablation. We reviewed the few reported cases of splenic metastasis (from colorectal and other primary cancers) treated by thermal ablation using radiofrequency (RF) or microwave (MW) energy sources. Many studies have proved that thermal ablation for benign splenic pathology is both feasible and safe with no sacrifice in efficacy. However only a few cases of MW or RF treatment of splenic secondary tumor have been described; no complications have been reported with this treatment in contrast to the 15 to 27% morbidity rate for splenectomy. When treatment of splenic metastasis is proposed with curative intent, thermal ablation by RF or by MW seems to be a feasible and safe technique resulting in spleen conservation with a low morbidity rate. Because of these features, thermal ablation seems an ideal treatment modality to obliterate splenic metastasis and may be an indispensable tool in the armamentarium of modern splenic surgery.

Splenectomy for splenic metastases from malignant adrenal pheochromocytoma: a case report.

Splenic metastasis is generally not a common clinical event. However, metastasis to the spleen from adrenal pheochromocytoma is extremely rare and has not been reported in literature. This report presents a case of a 58 year-old male patient who developed spleen-only metastases in July 2007. The patient had a previous history of left epinephroectomy for adrenal pheochromocytoma in January 2003. Abdominal computed tomography demonstrated multiple enhancing lesions suggestive of metastases; thus splenectomy was performed. Pathological examinations confirmed the diagnosis of splenic metastases from pheochromocytoma. The patient was alive without recurrence 48 months after splenectomy. This study is the first report on splenic metastasis from previous adrenal pheochromocytoma, and long-term survival was achieved by splenectomy. A history of malignancy indicates a high index of suspicion for splenic metastasis, and long-term survival can be achieved by splenectomy for spleen-only metastasis.

English

English

Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

Non-Small Cell Lung Cancer Stage IV Long-Term Survival With Isolated Spleen Metastasis

Splenic metastasis is rare and generally associated with disseminated disease, often seen in breast cancer, colorectal and ovarian carcinoma, and melanoma. Isolated metastasis to the spleen is rare, with only 93 cases from all sources having been reported up to 2007. Moreover, isolated splenic metastasis from primary lung cancer is extremely rare, with only 11 cases reported to date. We report a case of isolated splenic metastasis in a woman 8 months after lobectomy for an adenocarcinoma in the right lung completely resected. After 8 years of follow-up, the patient is still alive with no evidence of metastatic recurrence.

Laparoscopic Approach for Isolated Splenic Metastasis

Splenic metastases are extremely unusual. The aim of this paper is to review the world experience to date concerning to laparoscopic approach for splenic metastasis, and to report ours at the Hospital de Sant Pau. Literature review was carried out and relevant reports on laparoscopic approach to splenic metastasis were obtained. In addition, we reviewed our patient's database and retrieved the data of those who underwent laparoscopic splenectomy due to splenic involvement. Electronic search yielded 8 relevant articles on open splenectomy and 7 articles on laparoscopic splenectomy for splenic metastasis. During the study period, 6 patients were operated on laparoscopically. Primary neoplasms were 3 melanomas, 2 colon carcinomas, and 1 malignant fibrous histiocytoma. None of the patients had surgical complications. Outcome ranged from 2-month to 11-year survival. The laparoscopic approach for splenic metastasis is feasible. Of course, it must be individualized in each case.

Isolated and solitary splenic metastasis detected by positron emission tomography in a patient with malignant melanoma: and review of the literature

Splenic metastasis from malignant melanoma is an extremely rare occurrence and is most often reported during autopsy. As in other solid tumors, splenic metastasis is usually part of multiple organ metastases in melanoma and is rarely an isolated or solitary mass. As the use of positron emission tomography /computed tomography and imaging techniques become more common, splenic metastases are seen more often than before. Even though it is a commonly known fact that positron emission tomography/computed tomography is no help during primary staging and patient relations in malignant melanoma, several studies and meta-analyses have proven that it is more specific, sensitive and accurate to identify metastases than raditional methods. Therefore, using techniques with high specificity and accuracy rates such as positron emission tomography/computed tomography in the diagnosis of splenic metastasis in patients with malignant melanoma will increase the survival rate with an earlier splenectomy. We report the case of a 35-year-old male patient with cutaneous malignant melanoma whose splenic metastasis was detected with positron emission tomography/computed tomography. This article describes, with reference to the literature, a malignant melanoma case, which presented with splenomegaly and solitary mass lesion and was diagnosed as metastasis by splenectomy after positron emission tomography/computed tomography.

Laparoscopic splenic hilum lymph node dissection for advanced proximal gastric cancer: A modified approach for pancreas- and spleen-preserving total gastrectomy

To investigate the feasibility and optimal approach for laparoscopic pancreas- and spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric cancer. Between August 2009 and August 2012, 12 patients with advanced proximal gastric cancer treated in Nanfang Hospital, Southern Medical University, Guangzhou, China were enrolled and subsequently underwent laparoscopic total gastrectomy with pancreas- and spleen-preserving splenic hilum lymph node (LN) dissection. The clinicopathological characteristics, surgical outcomes, postoperative course and follow-up data of these patients were retrospectively collected and analyzed in the study. Based on our anatomical understanding of peripancreatic structures, we combined the characteristics of laparoscopic surgery and developed a modified approach (combined supra- and infra-pancreatic approaches) for laparoscopic pancreas- and spleen-preserving splenic hilum LN dissection. Surgery was completed in all 12 patients laparoscopically without conversion. Only one patient experienced intraoperative bleeding when dissecting LNs along the splenic artery and was handled with laparoscopic hemostasis. The mean operating time was 268.4 min and mean number of retrieved splenic hilum LNs was 4.8. One patient had splenic hilum LN metastasis (8.3%). Neither postoperative morbidity nor mortality was observed. Peritoneal metastasis occurred in one patient and none of the other patients died or experienced recurrent disease during the follow-up period. Laparoscopic total gastrectomy with pancreas- and spleen-preserving splenic hilum LN dissection using the modified approach for advanced proximal gastric cancer could be safely achieved.

Rare case of isolated splenic metastases from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography

We report a rare case of isolated splenic metastasis from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT). A 55-year-old man with gastric cancer 1 year post surgery, evaluated with PET/CT showed focal, intense uptake in the spleen, with no other abnormal findings. On splenectomy, the lesion was confirmed as metastasis from gastric cancer pathologically.

大腸癌異時性孤立性脾転移の１例および本邦報告例の検討

大腸癌異時性孤立性脾転移の１例および本邦報告例の検討

孤立性脾転移をきたした肺腺癌の1例

孤立性脾転移をきたした肺腺癌の1例

Solitary Splenic Metastasis from Head and Neck Cancer: A Case Report

Solitary splenic metastases from head and neck cancer are rare. We report a 35-year-old male with nasal cavity cancer with metastasis to the cervical lymph nodes. The patient underwent three cycles of induction chemotherapy, followed by left medial maxillectomy with modified radical neck dissection and concurrent chemoradiotherapy with weekly cisplatin. After 7 months of a disease-free interval, positron-emission tomography showed a high uptake in the spleen, and a biopsy confirmed metastatic carcinoma. After four cycles of systemic chemotherapy with docetaxel and cisplatin, laparoscopic splenectomy was performed. This case highlights that solitary splenic metastasis, although rare, may occur with a locoregionally controlled head and neck cancer and could be treated with local and systemic treatment. (Korean J Med 2013;85:324-328)

盲腸癌孤立性脾転移の1例

盲腸癌術後3年目に孤立性脾転移をきたし，腹腔鏡補助下脾摘出術を施行した1例を経験したので報告する．症例は68歳男性，盲腸癌にて結腸右半切除術，D3郭清を施行した（C，2型，50×45mm，SE，N1，H0，P0，M0，Stage IIIa）．術後3年目のスクリーニング腹部造影CT検査にて脾臓に2.5cm大の造影効果が乏しい円形の腫瘤性病変を認めた．FDG-PET検査にて脾腫瘤に一致して強い集積を認めたが，他部位に集積は認めなかった．盲腸癌の孤立性脾転移と診断し，腹腔鏡補助下脾摘出術を施行した．手術時間2時間56分，出血量は8gであった．病理組織学的検査で大腸癌の転移性脾腫瘍と診断された．術後経過良好で，術後8日目に退院した．術後3年の現在まで再発や転移は認めていない．

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

腹腔鏡下脾臓摘出術を施行した卵巣癌術後孤立性脾転移の1例

患者は，74歳，女性．1997年6月に卵巣癌の診断で手術施行（漿液性腺癌，pT3b N1M0 Stage IIIc）．2007年には左乳癌（Stage I），2009年には右乳癌（Stage I）の診断で乳房部分切除術を施行．2010年4月のCT検査にて脾臓に5mm大の腫瘍を認めフォローされていたが，2012年3月のCT検査では28mmに増大した．FDG-PET検査では脾臓に集積を認めるが他部位には集積なく，孤立性脾転移の疑いで腹腔鏡下脾臓摘出術を施行した．病理診断は漿液性腺癌で卵巣癌の脾臓転移と診断した．術後補助療法は行わず経過観察中で，術後7カ月の現在，無再発生存中である．孤立性脾転移は稀であり，術前には確定診断が困難で，診断と治療を目的とした手術を選択することも多い．そのような症例では低侵襲な腹腔鏡下脾臓摘出術が有用であると考えられた．

Inhibition of Filamin-A Reduces Cancer Metastatic Potential

Filamin-A cross-links actin filaments into dynamic orthogonal networks, and interacts with an array of proteins of diverse cellular functions. Because several filamin-A interaction partners are implicated in signaling of cell mobility regulation, we tested the hypothesis that filamin-A plays a role in cancer metastasis. Using four pairs of filamin-A proficient and deficient isogenic cell lines, we found that filamin-A deficiency in cancer cells significantly reduces their migration and invasion. Using a xenograft tumor model with subcutaneous and intracardiac injections of tumor cells, we found that the filamin-A deficiency causes significant reduction of lung, splenic and systemic metastasis in nude mice. We evaluated the expression of filamin-A in breast cancer tissues by immunohistochemical staining, and found that low levels of filamin-A expression in cancer cells of the tumor tissues are associated with a better distant metastasis-free survival than those with normal levels of filamin-A. These data not only validate filamin-A as a prognostic marker for cancer metastasis, but also suggest that inhibition of filamin-A in cancer cells may reduce metastasis and that filamin-A can be used as a therapeutic target for filamin-A positive cancer.