Splenic Metastasis Research Articles

Solitary Splenic Metastasis of an Ovarian Carcinoma After 7 Years of Remission

Solitary Splenic Metastasis of an Ovarian Carcinoma After 7 Years of Remission

Evaluation of the incidence of splenic hilar lymph node metastasis in patients operated on for esophagogastric junction cancer

Evaluation of the incidence of splenic hilar lymph node metastasis in patients operated on for esophagogastric junction cancer

Prevention and management of complications related to laparoscopic spleen-preserving hilar lymph node dissection for gastric cancer

Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer. Laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSHLD) can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis. However, LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer. Moreover, improper operation can easily lead to splenic vascular injury, spleen injury and pancreatic injury and other related complications, due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore, in the prevention and treatment of LSPSHLD-related complications, we should first focus on prevention, clarify the indication of surgery, and select the benefit group of LSPSHLD individually, so as to avoid the risk caused by over-dissection. Meanwhile, during the perioperative period of LSPSHLD, it is necessary to improve the cognition of related risk factors, conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury, and master the surgical skills and effective measures to deal with related complications, so as to improve the surgical safety of LSPSHLD.

Cutaneous Malignant Melanoma Presenting as an Isolated Splenic Metastasis: An Update.

Although the spleen is a highly vascularized organ, metastatic deposits from non-hematolymphoid solid malignancies are rare. This is reasoned to the inherent resistance of the splenic parenchyma to harbor metastases. The splenic capsule, lack of afferent lymphatics, contractile properties of the spleen, and the angular and gyroid course of the splenic artery form several barriers against the metastatic spread of malignant tumors. Moreover, the immune cells in the white and red pulps of the spleen have strong defensive ability against the tumor cells. Metastasis from solid tumors to the spleen often occurs only during widespread distant spread. Malignant melanoma is a rare but fatal malignancy. Isolated splenic metastasis from malignant melanoma is exceptionally rare. Studies that addressed the splenic metastasis from cutaneous malignant melanoma are scarce. This minireview was performed to address this subject. Here we present an overview of the clinicopathologic features of isolated splenic metastatic melanoma. The diagnostic biochemical markers in melanoma are also discussed.

Pancreatic Malignancy Masquerading as a Splenic Lesion: A Case Report

Splenic metastases are rarely encountered in routine clinical practice, and they may be due to various reasons, such as anatomical or immunological factors. Splenic metastasis is usually seen in the setting of disseminated disease. It is rare for pancreatic malignancy to present as a predominant splenic mass. Hereby, the authors present a case of 65-year-old female who presented with a painful lump in the left hypochondrium, along with loss of appetite and weight loss over the past two months. Preoperative Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans diagnosed patient with a primary splenic tumour. She underwent enbloc resection of the spleen and adherent pancreatic tail, along with station 9d and 10 lymph nodes. Histopathological Examination (HPE) with Immunohistochemistry (IHC) revealed a small subcentimeter primary lesion in the pancreatic tail region with splenic extension and multiple metastases, including areas of central necrosis. Patient was then put on gemcitabine-based chemotherapy. Preoperative imaging modalities such as CT and MRI scans, as well as tumour markers, also failed to reveal the pancreatic lesion. The present case highlights a rare clinical scenario of a hidden pancreatic lesion with large and multiple splenic metastases. Splenic lesions can create diagnostic confusion between benign and malignant lesions on imaging, and it can be challenging to differentiate between primary or secondary lesions. When there is suspicion of splenic metastasis, particularly isolated secondaries, the pancreas should also be considered in the differentials, especially when no other primary is identified on routine imaging.

Recurrence of Poorly Differenciated Cervical Cancer by Single Splenic Metastasis: Case Report and Literature Review

Background: The incidence of cervical cancer in Belgium is 11.1 per 100,000. With the introduction of cervical cytology screening and more recently anti-HPV vaccination, this rate has been decreasing for almost 20 years. Despite this, some patients are missed by the screening and prevention system and cervical cancer is still diagnosed at an advanced stage. Recurrences by splenic metastases are rare and are most often found at autopsy. Case Study: We describe the case of a 41-year-old caucasian patient with a single splenic recurrence after radiotherapy, chemotherapy, brachytherapy, and surgery for a poorly differentiated adenocarcinoma of the cervix grade 3 at an initial stage IIB according to FIGO. This recurrence happens 3 years after the initial treatment. After monitoring this asymptomatic lesion, the size increase results in laparoscopic splenectomy. Histology demonstrates a splenic metastasis recurrence of adenocarcinoma of endocervical origin. Conclusion: The spleen is a rare metastatic site in cervical cancer. Splenectomy followed by chemotherapy is the therapy most often found in the literature, which is however poor in this regard.

Cell Heterogeneity in Isolated Splenic Metastasis of Ovarian Cancer Revealed by Single-Cell RNA Sequencing

Cell Heterogeneity in Isolated Splenic Metastasis of Ovarian Cancer Revealed by Single-Cell RNA Sequencing

Splenic Metastatic Choriocarcinoma with Nontraumatic Splenic Rupture: A Case Report and Literature Review

Choriocarcinoma is a highly malignant trophoblastic tumor that occurs mostly in women of childbearing age. The main mode of metastasis is hematogenous metastasis. The most common sites of metastasis are the lung, vagina and brain, while splenic metastasis is rare. Because of its rapid development, extensive metastasis can occur in a short period, and some patients only show metastatic symptoms, which are often missed or misdiagnosed as ectopic pregnancy or other diseases. We describe a rare case of splenic metastatic choriocarcinoma with acute abdominal pain caused by nontraumatic splenic rupture. In addition, we review the previous literature on splenic metastasis of choriocarcinoma and summarize the clinical manifestations, management measures and prognoses. Our case and literature review indicate that splenic metastatic choriocarcinoma is rare and difficult to distinguish from splenic ectopic pregnancy and other diseases. Clinicians should strengthen their understanding of this disease and avoid misdiagnosis.

Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study.

Simple SummaryDistal pancreatectomy has become the standard surgery for patients with pancreatic body–tail cancers. The optimal area for dissection remains controversial, and there is an emphasis on preserving as much tissue as possible while eradicating the cancer. This multicenter, retrospective study evaluated the frequency and patterns of lymph node metastasis based on tumor site among 235 patients with pancreatic body–tail cancers to determine the optimal lymph node dissection area for distal pancreatectomy. Patients with pancreatic body cancer tumors showed no metastasis to the splenic hilum lymph node. Spleen-preserving pancreatectomy might be feasible for Pb cancer.Distal pancreatectomy (DP) with lymphadenectomy is the standard surgery for pancreatic body–tail cancer. However, the optimal lymph node (LN) dissection area for DP remains controversial. Thus, we evaluated the frequency and patterns of LN metastasis based on the tumor site. In this multicenter retrospective study, we examined 235 patients who underwent DP for pancreatic cancer. Tumor sites were classified as confined to the pancreatic body (Pb) or pancreatic tail (Pt). The efficacy index (EI) was calculated by multiplying the frequency of metastasis to each LN station by the five-year survival rate of patients with metastasis to that station. LN metastasis occurred in 132/235 (56.2%) of the patients. Patients with Pb tumors showed no metastasis to the splenic hilum LN. Distal splenic artery LNs and anterosuperior/posterior common hepatic artery LNs did not benefit from dissection for Pb and Pt tumors, respectively. In multivariate analysis, splenic artery LN metastasis was identified as an independent predictor of poor overall survival in patients with pancreatic body–tail cancer. In conclusion, differences in metastatic LN sites were evident in pancreatic body–tail cancers confined to the Pb or Pt. Spleen-preserving pancreatectomy might be feasible for Pb cancer.

Effect of splenic hilar lymphadenectomy on locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction with a tumor diameter ≥4 cm: a five-year survival analysis

Objective: To examine the long term outcome of splenic hilar lymphadenectomy (SHL) for locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) with a tumor diameter ≥4 cm. Methods: A total of 489 locally advanced Siewert type Ⅱ and Ⅲ AEG patients with a tumor diameter ≥4 cm who underwent radical resection from January 2010 to April 2016 were included. There were 383 males and 106 females. There were 225 patients aged≥65 years and 264 patients aged <65 years. SHL was conducted in 270 patients(SHL group). Wilcoxon rank-sum test or χ2 test were conducted for inter-group comparison. Cox proportional hazard regression was used to analyze the long term outcome of SHL and the prognosis factors of overall survival. Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Followed-up to April 2021,the median follow-up time was 78.0 months (range: 74.0 to 85.0 months), the follow-up rate was 95.5%(467/489). The splenic hilar lymphnode metastasis rate of the SHL group was 12.6% (34/270). Younger patients (<65 years old), less complications, higher proportion of patients received adjuvant chemotherapy were demonstrated in the SHL group (χ2: 5.644 to 6.744, all P<0.05). Multivariate analysis showed that SHL was the independent prognosis factor of overall survival for patients with Siewert type Ⅱ and Ⅲ AEG and a tumor diameter≥4 cm (HR=0.68, 95%CI: 0.52 to 0.88, P=0.004) along with preoperative CA19-9, pathological T stage, pathological N stage, adjuvant chemotherapy and postoperative complication. Further subgroup analysis demonstrated that the SHL group had better 5-year overall survival than non-SHL group (62.4% vs. 39.2%, χ2=17.983, P=0.006) in Siewert type Ⅲ AEG rather than in Siewert type Ⅱ AEG(57.3% vs. 53.7%, χ2=3.031, P=0.805). Conclusion: In experienced center, splenic hilar lymphadenectomy can improve the prognosis of Siewert type Ⅲ AEG with a tumor diameter ≥4 cm.

Spleen metastases secondary to gastric neuroendocrine carcinoma: case report.

Neuroendocrine carcinoma (NEC) in the stomach represents a rare and rapidly growing type of gastric tumors. They are considered a distinct entity of neuroendocrine tumors characterized by an aggressive behavior and high metastases rate. On the other hand, spleen metastases of neuroendocrine tumors are extremely rare. We report the first case of spleen metastases of gastric neuroendocrine carcinoma. The patient was a 54-year-old male who presented with a 10-month history of epigastralgia. Upper gastro-intestinal endoscopy revealed a 5 cm ulcerative lesion located in the greater gastric curvature. Biopsies with immunohistochemical staining revealed gastric neuroendocrine carcinoma. Abdominal computed tomography showed thickening of the stomach with two large solid spleen lesions. Abdominal Magnetic Resonance Imaging and 18-fluorodexyglucose positron-emission tomography revealed peritoneal carcinosis and splenic metastases with splenic vein invasion. Clinicians should keep in mind that splenic metastases can arise from gastric neuroendocrine tumors (NETs).

Single Cutaneous Metastasis from Mucinous Adenocarcinoma of Prostate with Bladder Invasion: An Unusual Localization

Mucinous adenocarcinoma of the prostate is an extremely rare histological variant of prostate cancer. The malignancy potential, tumor grading, clinical course and prognosis of affected patients remain controversial. There are no data on the evolution of metastatic mucinous adenocarcinoma of the prostate. Our case describes the rapid and unfortunate evolution of a prostatic mucinous adenocarcinoma invading bladder with skin metastasis in a 47-year-old patient, who was hospitalized because of intermittent gross hematuria accompanied by bulky and dark red clots for more than two months. The diagnosis was confirmed after a prostatic Magnetic resonance imaging (MRI) and a transurethral resection of the prostate and bladder with anatomopathological study and immunohistochemical complement. The evolution was marked initially by the appearance cutaneous metastasis during his hospitalization and hepatic and splenic metastases 3 months after his initial extension workup which was negative; our patient is currently on his 2nd cycle of chemotherapy for palliative purposes. The aim of our article is to highlight the most important diagnostic features and specific aspects in the primary diagnosis of this tumor, which every urologist should keep in mind, and we will focus on the prognosis and the interest of an early and especially multidisciplinary management.

Successful treatment with laparoscopic surgery and sequential multikinase inhibitor therapy for hepatocellular carcinoma: A case report

BACKGROUNDHepatocellular carcinoma (HCC) with massive portal vein tumor thrombosis (PVTT) and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARYA 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization plus sorafenib for recurrence. Four years after initial hepatectomy, she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites. Her liver function was Child-Pugh B (8), and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were elevated up to 46.291 mAU/mL. Since initial treatment with regorafenib for three months was unsuccessful, the patient was administered lenvatinib. Ten months post-treatment, there was no contrast enhancement of PVTT or splenic metastasis. Chemotherapy was discontinued due to severe diarrhea. Afterward, splenic metastasis became viable, and PIVKA II increased. Therefore, hand-assisted laparoscopic splenectomy was performed. She experienced no clinical recurrence 14 mo after resection.CONCLUSIONConversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.

Early solitary splenic metastasis of endometrial cancer: a case report and review of literature

Early solitary splenic metastasis of endometrial cancer: a case report and review of literature

Partial splenectomy after preoperative embolization in a patient with metastatic melanoma - A case report.

Introduction and importanceThere is lack of evidence regarding the best treatment option for metastatic melanoma. In patients with a single splenic metastasis, preoperative superselective embolization followed by partial splenectomy (PS) could be a feasible treatment strategy to preserve splenic function and hopefully reduce the risk of postoperative bleeding. To our knowledge, this two-step procedure has yet not been published in patients with splenic metastasis.Case presentationWe present the case of a 73-year-old man with stage IV melanoma consisting of a single splenic metastasis located at the lower pole. Four days prior to surgery, the patient underwent percutaneous superselective embolization of the segmental arteries going to the lower splenic pole. Subsequent, PS was performed using an upper midline laparotomy were a clearly visible tumor was found at the devascularized lower third of the spleen. The splenic parenchyma was divided using an energy device and hemostasis was secured with diathermia and a hemostatic patch. The patient had an uncomplicated recovery and was discharged home on postoperative day 8. Histology revealed an 8 mm, partly necrotic metastasis from a melanoma. There were no signs of recurrency at his last control four months postoperative.Clinical discussionThere are no guidelines on how splenic metastasis from melanoma are to be removed, nor any literature on postoperative splenic function or survival after PS.ConclusionSuperselective embolization followed by PS for metastatic melanoma could be a feasible treatment approach in highly selective patients where there is a strong desire to preserve splenic function.

Successful Multidisciplinary Treatment with Laparoscopic Surgery and Sequential Multikinase Inhibitor Therapy for Multivisceral Recurrence of Hepatocellular Carcinoma

Background: Hepatocellular carcinoma with massive portal vein tumor thrombosis and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary treatment of sequential multikinase inhibitor and laparoscopic surgery for multivisceral recurrence. Case presentation: A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with liver tumor. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization and sorafenib for recurrence. Four years after the initial hepatectomy, she was found to have a 43 mm mass in the spleen and a tumor thrombus that involved the right anterior portal branches down to the main trunk with severe ascites. Her liver function was Child-Pugh B (8), and PIVKA II levels were elevated up to 46,291 mAU/mL. The patient was initially treated with regorafenib but experienced disease progression 3 months later with a maximum PIVKA II value of 129,815 mAU/mL. The patient was then administered lenvatinib. Eighteen months after the treatment, there was no contrast enhancement of the portal vein tumor thrombosis and splenic metastasis. This chemotherapy was discontinued because of grade 3 diarrhea. Afterward, splenic metastasis increased again with the rise in PIVKA II. Therefore, hand-assisted laparoscopic splenectomy was performed. The patient was discharged 10 days postoperatively. There was no clinical evidence of recurrence 14 months after resection. Conclusion: Conversion surgery after successful multikinase inhibitor treatment is considered an effective treatment option for advanced HCC.

Solitary Splenic Metastasis of Fallopian Tube Carcinoma: A Case Report and Review of Literature

Solitary Splenic Metastasis of Fallopian Tube Carcinoma: A Case Report and Review of Literature

A splenic hamartoma: Adding a new case to the literature: A case report.

IntroductionSplenic tumours are relatively rare and include malignancies such as lymphomas, angiosarcomas, plasmacytomas, primary malignant fibrous histiocytomas, and splenic metastases. Benign tumours of the spleen such as hemangiomas, cysts, and inflammatory pseudotumours are very rare (Kaza et al., 2010, PisaniCeretti et al., 2012) [1], [2]. There are fewer than 160 cases of splenic hamartoma or splenomas having been reported in the literature (Basso et al., 2012) [3]. Only 20% of the cases were detected in children (Abramowsky et al., 2004) [4]. Although multi-modality imaging findings were described preoperatively, the final diagnosis was splenic hamartoma based on histology and immunohistochemistry.Case reportHere, we report a case of a14 year old child left upper quadrant abdominal pain and worsening sickness. Multi-modality imaging detected a solid lesion of the spleen, who required splenectomy and was pathologically diagnosed as a splenic hamartoma. The postoperative course was uneventful.DiscussionSplenic hamartoma is very rare. Only 20% of hamartomas occur in children. They are commonly found incidentally on imaging with no symptoms.ConclusionSplenic hamartoma is a benign vascular proliferative lesion that requires a multi-modality imaging studies for diagnosis and confirmed by histopathology. It must be included in the differential diagnosis of splenic mass forming lesions.

Outcomes of Laparoscopic Total Gastrectomy Combined With Spleen-Preserving Hilar Lymphadenectomy for Locally Advanced Proximal Gastric Cancer

The long-term survival of patients with laparoscopic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy (LSTG) for advanced upper-third gastric cancer (AUTGC) and the association of splenic hilar lymph node (LN-10) metastasis with survival remain controversial. To evaluate the long-term outcomes of LSTG and the value index of LN-10 metastasis for patients with AUTGC. The Chinese Laparoscopic Gastrointestinal Surgery Study 4 (CLASS-04) was a prospective, multicenter, single-arm trial that involved 19 centers in China. A total of 251 eligible patients with clinical stage T2, T3, or T4a upper-third gastric cancer without distant metastases were enrolled from September 1, 2016, to October 31, 2017. The final follow-up was on December 31, 2020. All patients were enrolled to undergo LSTG. The main outcomes were the 3-year overall survival (OS) and disease-free survival (DFS). Multivariate analyses were used to explore the association of LN-10 metastasis with survival. Among the 251 patients, 246 (98.0%; mean [SD] age, 60.1 [9.4] years; 197 [80.1%] male) underwent LSTG and completed the study. The 3-year OS was 79.1% (95% CI, 74.0%-84.2%), and the 3-year DFS was 73.1% (95% CI, 67.4%-78.8%). In addition, the 3-year therapeutic value index of LN-10 dissection was 4.5, exceeding the indexes for the partial D2 LN group (including LNs 5, 6, 11d, and 12a). Nineteen patients (7.7%) with LN-10 metastasis had significantly worse survival than the nonmetastasis group, and multivariate analysis revealed that splenic LN-10 metastasis was an independent risk factor (OS: hazard ratio [HR], 2.38; 95% CI, 1.08-5.26; P = .03; DFS: HR, 2.28; 95% CI, 1.12-4.63; P = .02). Moreover, patients with LN-10 metastasis were more likely to have recurrence (42.1% vs 20.7%, P = .03), especially when multiple site metastasis was present (21.1% vs 4.4%, P = .01). However, patients with LN-10 metastasis who received adjuvant chemotherapy had significantly better OS and DFS than those without adjuvant chemotherapy and achieved the same oncologic effect as those without LN-10 metastasis. This results of this study suggest that LSTG for AUTGC has feasible long-term outcomes. In addition, patients with LN-10 metastasis may have worse survival and may be more prone to recurrence.

Sleep fragmentation enhances inflammation and compromises stress-responsive neuronal activity following traumatic brain injury

There is lack of evidence regarding the best treatment option for metastatic melanoma. In patients with a single splenic metastasis, preoperative superselective embolization followed by partial splenectomy (PS) could be a feasible treatment strategy to preserve splenic function and hopefully reduce the risk of postoperative bleeding. To our knowledge, this two-step procedure has yet not been published in patients with splenic metastasis.We present the case of a 73-year-old man with stage IV melanoma consisting of a single splenic metastasis located at the lower pole. Four days prior to surgery, the patient underwent percutaneous superselective embolization of the segmental arteries going to the lower splenic pole. Subsequent, PS was performed using an upper midline laparotomy were a clearly visible tumor was found at the devascularized lower third of the spleen. The splenic parenchyma was divided using an energy device and hemostasis was secured with diathermia and a hemostatic patch. The patient had an uncomplicated recovery and was discharged home on postoperative day 8. Histology revealed an 8 mm, partly necrotic metastasis from a melanoma. There were no signs of recurrency at his last control four months postoperative.There are no guidelines on how splenic metastasis from melanoma are to be removed, nor any literature on postoperative splenic function or survival after PS.Superselective embolization followed by PS for metastatic melanoma could be a feasible treatment approach in highly selective patients where there is a strong desire to preserve splenic function.