Solitary metastatic carcinoma of the spleen

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).

Splenic metastases--not a frequent problem, but an underestimate location of metastases: epidemiology and course

OBJECTIVE

In the literature the frequency of splenic metastasis is documented very inconsistently. Only metastases of ovarial cancer are recommended for a surgical therapy. We examined the frequency of splenic metastasis in our hospital.

METHOD

The data of the Tumorboard Schwerin has been analyzed for splenic metastases. Based on hospital documents and contact via telephone the clinical course of the patients was also examined.

RESULTS

A total of 6,137 of 29,364 patients with malignant tumors developed metastases (20.9%). We found 59 of these patients with splenic metastases (0.96%; 0.002% of all patients with malignant tumors). Men were more frequently concerned then women. The median age of the patients was 62 (26-88) years. There are only a few primary tumors metastasized in more than 1% into the spleen. A total of 47% of these metastases were synchronous, 53% metachronous. Only three patients had isolated splenic metastasis. Two further patients also had lymph node metastasis in the splenic hilus. Two other patients developed liver metastases after splenectomy. We performed four splenectomies because of splenic metastasis. The survival of splenic metastasis was median 3 (0-61) months.

DISCUSSION

The published studies of the frequency of the splenic metastasis are autopsy studies, which are not usable for epidemiological statements because of selection bias. We show that splenic metastases arise in less than 1% of all metastases. A splenectomy in case of splenic metastases makes sense, if the metastases are isolated. It is also meaningful as a debulking procedure that would be followed by a chemotherapy, e.g. in case of an ovarial carcinoma. As a result the survival is increased for patients undergoing splenectomy (median survival 19.5 vs. 3 months).

Metastatic disease to the pancreas and spleen

Isolated metastases to the pancreas and spleen are a rare occurrence. When they are diagnosed, pancreatic metastases are most often from renal cell carcinoma, lung cancer, and breast cancer. The most common source of splenic metastases is gynecological in origin; the overwhelming majority is ovarian. If extensive staging studies reveal these metastases to be isolated, then curative resection may be warranted. This review will demonstrate that long-term survival may be achieved in patients with isolated metastases and a prolonged disease-free interval.

Solitary splenic metastasis: case report and review of the literature

Solitary splenic lesion is a rare presentation of a previous or current malignancy. We describe a case of an isolated splenic lesion caused by endometrial carcinoma and summarize all the published reports on solitary splenic metastasis.

Splenectomy for Splenic Metastases: A Changing Clinical Spectrum

Splenic metastases from solid tumors are unusual with only scattered case reports of patients treated with splenectomy before 1987. We conducted a retrospective chart review at our large tertiary-care private teaching hospital between January 1990 and September 1999 and found splenic metastases in 31 patients. In eight patients (26%), the spleen was the only site of metastatic disease. Of the 31 splenectomies for metastases, 23 were performed for ovarian neoplasms, five during primary operative procedures, and 18 during secondary cytoreductive procedures or explorations for late recurrences at an average of 3.9 years after the original operation. Nearly half of the metastases (15 of 31) appeared entirely within the splenic parenchyma, representing probable hematogenous spread, whereas seven involved both the splenic parenchyma and capsule and nine involved the capsule only. Between 1990 and 1999 we identified a statistically significant increase in use of splenectomy for treatment of metastatic tumor with a Spearman rank correlation value of 0.86 ( P < 0.05). Most of this increase was attributable to ovarian cancer cases and may be due to expansion of treatment options or improved imaging methods. We report the largest series of splenectomy for splenic metastases and the ninth case report in the world literature of splenectomy for isolated splenic metastasis due to colorectal cancer.

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.

Massive splenomegaly with multiple defects in a chronic myelogenous leukemia demonstrated by 99mTc-sulfur colloid scintigraphy

A 99mTc-sulfur colloid liver-spleen scintigram of a 78-year-old woman with a painful, large mass in the left upper quadrant of the abdomen revealed massive splenomegaly with multiple areas of absent radioactivity. Splenectomy was performed and the removed spleen, weighting 2,010 g, was confirmed to contain acute and old infarcts with leukemic cell and megakaryocyte infiltration.

Prognostic effect of early diagnostic splenectomy in Hodgkin's disease: a randomized trial

A randomized trial is reported which evaluates the effect of early diagnostic splenectomy on the prognosis of patients with Hodgkin's disease (HD) and uncertain prognosis. This was started in January 1973 and concluded in April 1979. Sixty-seven patients were entered in the study and 31 were randomized for splenectomy. All patients except 2 received total nodal irradiation, excluding the splenic and hepatic areas. After 40 months' observation there was no difference between the groups in respect of survival and the number of recurrences. However, relapses occurred earlier in the splenectomized patients. Pneumococcal septicaemia was recorded in 2 splenectomized patients. It is concluded that prognosis is not improved by diagnostic splenectomy in HD patients with uncertain prognosis and treated with total nodal irradiation.

Splenic function: normal, too much and too little

This review is concerned with normal splenic function, mechanisms and consequences of splenomegaly, hypersplenism, the medical indications for splenectomy and the various aspects of hyposplenism. The potential probelm of lethal septicemia in hyposplenic or asplenic patients is also considered.