Isolated splenic metastasis from gastric carcinoma: value of CEA and CA 19-9 in early diagnosis: report of two cases

Isolated Spleen Metastases of Endometrial Cancer: A Case Report

BACKGROUND

Isolated splenic metastases from endometrial cancer, which is a relatively common malignancy, are extremely rare findings; to date, only 14 cases have been reported in the literature.

CASE SUMMARY

We report a patient with isolated splenic metastases of endometrial cancer 3 years after radical surgery of the primary tumor. The patient was successfully treated by splenectomy and six cycles of paclitaxel. Fifty months after splenectomy, she was alive and well, and with no evidence of disease.

CONCLUSION

Isolated spleen metastasis of endometrial cancer is very rare. Radical surgery and adjuvant therapy may offer excellent long-term survival.

A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer

Background

Very rarely does a splenic solitary metastasis arise from a gastric carcinoma because splenic metastasis is usually seen in association with widespread visceral metastasis. Splenectomy is considered to be a curative treatment; however, long-term prognosis after splenectomy has scarcely been reported. We report a case of a metachronous and solitary metastasis to the spleen from gastric cancer in which the patient achieved 5-year recurrence-free survival after splenectomy.

Case presentation

An 84-year-old man underwent an open total gastrectomy involving D1+ lymph nodes dissection for gastric cancer located in the cardia (pT3N1M0, pStage IIB). Eighteen months later, a 2-cm solitary hypodense lesion was detected in the spleen by computed tomography (CT). Twenty-three months later, the serum carcinoembryonic antigen (CEA) value elevated to 19.9 ng/ml, and abdominal CT revealed an increase in tumor size to 5 cm. Positron-emission tomography (PET)-CT revealed intense ¹⁸F-2-deoxy-2-fluoro-glucose (FDG) uptake in the spleen without the involvement of other organs and lymph nodes. We diagnosed him with solitary splenic metastasis from gastric cancer and performed a splenectomy 26 months after the first surgery. Histological examination revealed that the splenic tumor was a moderately differentiated adenocarcinoma, which was very similar to the primary gastric tumor; the lesion was diagnosed as a metastatic tumor from the previous gastric carcinoma. The patient remains healthy to date without recurrence, 5 years after the splenectomy.

Conclusion

We experienced a case of a solitary splenic metastasis from gastric cancer in which 5-year recurrence-free survival was achieved after splenectomy. To determine the surgical indication in patients with splenic metastasis, it is important to differentiate between a solitary lesion or multiple metastasis. Especially, occult metastasis should be excluded by means of several months of follow-up with imaging tests and systemic FDG-PET surveys before splenectomy.

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

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.

Surgical resection of splenic metastasis from the adenosquamous gallbladder carcinoma: A case report

INTRODUCTION

Splenic metastasis of gallbladder carcinoma is extremely rare. Specific anatomical, histological, and functional properties of spleen are believed to be responsible for the rarity of solitary splenic metastasis.

PRESENTATION OF CASE

We present the case of a 62-year-old female who developed metachronous splenic metastasis of adenosquamous carcinoma of the gallbladder. We performed central bisegmentectomy of the liver for gallbladder carcinoma. The patient subsequently presented 3 months later with isolated splenic metastasis and liver metastasis. Splenectomy and partial hepatectomy was performed at this time. Histological examination confirmed metastatic adenosquamous carcinoma of the gallbladder. No signs of recurrence were observed at 3 months after the second surgery.

DISCUSSION

Although splenectomy provides a potential means of radical treatment in patients with isolated splenic metastases, it should be performed with caution as splenic metastatic lesions may represent the initial clinical manifestation of systemic metastases at multiple sites. In this case, radical surgery was performed following the confirmation of no new unresectable metastatic lesions or systemic dissemination.

CONCLUSION

This is the first report on the adenosquamous splenic metastasis from the gallbladder carcinoma. Curative resection may be the treatment of choice for prolonging survival in patients with the splenic metastasis of gallbladder carcinoma.

Splenic metastasis from gastric adenocarcinoma: A rare case

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We present a case of a 71-year-old patient with isolated splenic metastasis, diagnosed 6 years after primary treatment of a gastric adenocarcinoma, who underwent splenectomy.

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Isolated splenic metastasis, particularly from gastric adenocarcinoma, are rare.

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In cases of isolated splenic metastasis from gastric adenocarcinoma, fit patients should be considered for splenectomy, since there are reports of good patient survivals.

INTRODUCTION

Isolated splenic metastasis are very rare. There are only a few reported cases of patients with isolated splenic metastasis from gastric primary tumors.

PRESENTATION OF CASE

We present a case of a 71-year-old patient with isolated splenic metastasis, diagnosed 6 years after primary treatment of a gastric adenocarcinoma, who previously had a lung resection also for metastasis. The patient was submitted to chemotherapy and then to splenectomy. The patient is alive and has no evidence of disease 7 months after splenectomy.

DISCUSSION

We discuss the theories that explain the rare event of splenic metastasis, the route of metastization, the workup, treatment and survival of patients with isolated splenic metastasis. To the best of our knowledge, our case has the second longest interval from the primary diagnosis of gastric cancer to the diagnosis of splenic metastasis.

CONCLUSION

In cases of isolated splenic metastasis from gastric adenocarcinoma, fit patients should be considered for splenectomy, since there are reports of good patient survivals.

Isolated splenic metastasis of ovaric cancer. Case report and literature review

Splenic metastasis is extremely rare and are usually found in conjunction with metastasis of other organs. In addition, late recurrence even after 10 years of operation is very unusual. The most common sources of splenic metastasis are lung, colonrectal, melanoma, breast and ovarian carcinoma. We present a case of 67 year old woman who was admitted to our department with a solitary splenic metastases after hysterectomy with bilateral salpingo-oophorectomy for ovaric carcinoma 10 years ago. In conclusion, solitary splenic metastasis are very rare and the incidence of the reported cases in the medical literature is increasing. The treatment of choice is laparoscopic splenectomy that must be followed by chemotherapy in order to prevent the development of other possible micrometastases.

Isolated splenic metastases from gastric carcinoma: A case report and literature review

Isolated metastases to the spleen from gastric carcinoma is very rare. Only a few cases have been reported in the literature. We herein present a case of isolated splenic metastases in a 62-year-old man, occurring 12 mo after total gastrectomy for gastric carcinoma. The patient underwent a laparoscopic exploration, during which two lesions were found at the upper pole of the spleen, without involvement of other organs. A laparoscopic splenectomy was performed. Histological examination confirmed that the splenic tumor was a poorly differentiated adenocarcinoma similar to the primary gastric lesion. The postoperative course was uneventful and the patient has been well for 9 mo, with no tumor recurrence. The clinical data of 18 cases of isolated splenic metastases from gastric carcinoma treated by splenectomy were summarized after a literature review. To our knowledge, this is the first reported case of isolated splenic metastases undergoing laparoscopic splenectomy.

Laparoscopic approach for isolated splenic metastasis: comprehensive literature review and report of 6 cases

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

The laparoscopic approach for splenic metastasis is feasible. Of course, it must be individualized in each case.

Five serum proteins identified using SELDI-TOF-MS as potential biomarkers of gastric cancer

OBJECTIVE

The aims of this study were to detect serum proteomic patterns in gastric cancer serum samples using Surface-enhanced Laser Desorption/ionization-Time-of-flight-Mass Spectrometry ProteinChip array technology, to screen biomarker candidates, to build diagnostic models and to evaluate their clinical significance.

METHODS

Serum samples from patients with gastric cancer and normal healthy control subjects (n = 125) were analysed using surface-enhanced laser desorption/ionization technology. The spectra were generated on weak cation exchange (WCX2) chips, and protein peak clustering and classification analyses were established using Ciphergen Biomarker Wizard and Biomarker Pattern software, respectively. The diagnostic models were developed and validated by discriminant analysis. In addition, the results of the surface-enhanced laser desorption/ionization model were compared with the biomarkers carcinoembryonic antigen and carbohydrate antigen 199 in a subset of samples using a microparticle enzyme immunoassay.

RESULTS

Five protein peaks at 2046, 3179, 1817, 1725 and 1929 m/z were automatically chosen as components of the best biomarker pattern for diagnosis of gastric cancer. In addition, we identified a single protein peak at 4665 m/z, which could distinguish between stage I/II and stage III/IV gastric cancer with a specificity and sensitivity of 91.6% (11/12) and 95.4% (21/22), respectively. When this biomarker was validated in the second set of samples, the specificity and sensitivity were 91.7% (11/12) and 86.3% (19/22), respectively.

CONCLUSIONS

The present results suggest that serum surface-enhanced laser desorption/ionization protein profiling can distinguish patients with gastric cancer, and in particular stage I/II patients, from normal subjects with a relatively high sensitivity and specificity. Surface-enhanced Laser Desorption/ionization-Time-of-flight-Mass Spectrometry is a potential new diagnostic tool for the screening of gastric cancer.

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 giant splenic metastasis in a patient with metachronous gastric cancers

Splenic metastases from solid tumors are uncommon. They may be observed in a context of multivisceral dissemination or as a solitary lesion. We report the case of an 80-year-old woman with a history of two metachronous gastric cancers treated with distal gastrectomy and resection of the gastric remnant within a period of 15 years, who presented with a huge splenic tumor mass three years after the second operation. Splenectomy was performed. The resection specimens showed a well-circumscribed solid lesion measuring 15 cm in the largest diameter. Histology revealed metastatic gastric cancer. The differential diagnosis and clinical significance of this rare condition is discussed.

Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis

CONTEXT

Splenic metastases from solid tumors, defined as parenchymal lesion, are considered exceptional. Nevertheless, the number of case reports has been increasing due to the improvement of imaging techniques and the long-term follow-up of patients with cancer. Splenic metastases occur in a context of multivisceral disseminated cancer or as a solitary lesion.

OBJECTIVE

To provide a general overview of the clinicopathologic features, differential diagnosis, and pathogenesis of splenic metastases.

DATA SOURCES

Relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: (metastasis or metastases) and spleen.

CONCLUSIONS

The most common primary sources of splenic metastasis are breast, lung, colorectal, and ovarian carcinomas and melanoma in cases of multivisceral cancer and colorectal and ovarian carcinomas in cases of solitary splenic lesion. Splenectomy can be replaced by less aggressive methods such as fine-needle aspiration or percutaneous biopsy for establishing the diagnosis of solitary splenic metastasis. The main differential diagnoses are primary lymphoma, vascular tumors, and infectious lesions of the spleen. The relative rarity of splenic metastases could be explained by anatomic factors and the inhibitory effect of the splenic microenvironment on the growth of metastatic cells. The analysis of clinical case reports suggests that solitary splenic metastases may result from the growth of an early blood-borne micrometastasis following a period of clinical latency, often several years after the diagnosis of the primary tumor.

[Spontaneous splenic rupture due to splenic metastasis of lung cancer]

We report the case of a patient who underwent splenectomy for spontaneous rupture of the spleen due to splenic metastasis. Pathologic examination revealed diffuse infiltration by carcinoma. Chest X-ray revealed a right lung superior lobe tumor, related to poorly differentiated carcinoma. Total splenectomy is a good option for diagnosis and treatment of splenic metastases.