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Tanioka N, Kuwahara M, Sakai T, Nokubo Y, Shimizu S, Hiroi M, Akimori T. Minimally Invasive Conversion Surgery for Unresectable Gastric Cancer with Splenic Metastasis and Splenic Vein Tumor Thrombus: A Case Report. Curr Oncol 2024; 31:2662-2669. [PMID: 38785482 PMCID: PMC11119725 DOI: 10.3390/curroncol31050201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for patients with GC with distant metastasis and tumor thrombus are extremely scarce, and a definitive surgical strategy has yet to be established. Herein, we report a 67-year-old man with left abdominal pain referred to our hospital following a diagnosis of unresectable GC. Esophagogastroduodenoscopy and contrast-enhanced abdominal computed tomography (CT) revealed advanced GC with splenic metastasis. A splenic vein tumor thrombus (SVTT) and a continuous thrombus to the main trunk of the portal vein were detected. The patient was treated with anticoagulation therapy and systemic chemotherapy comprising S-1 and oxaliplatin. One year following chemotherapy initiation, a CT scan revealed progressive disease (PD); therefore, the chemotherapy regimen was switched to ramucirumab with paclitaxel. After 10 courses of chemotherapy resulting in primary tumor and SVTT shrinkage, the patient underwent laparoscopic total gastrectomy (LTG) and distal pancreaticosplenectomy (DPS). He was discharged without complications and remained alive 6 months postoperatively without recurrence. In summary, the wait-and-see approach was effective in a patient with GC with splenic metastasis and SVTT, ultimately leading to an R0 resection performed via LTG and DPS.
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Michio Kuwahara
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Takashi Sakai
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Yuzuko Nokubo
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Shigeto Shimizu
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Makoto Hiroi
- Department of Pathology, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan;
| | - Toyokazu Akimori
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
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Safai Zadeh E, Dietrich CF, Görg C, Bleyl T, Alhyari A, Ignee A, Jenssen C, Trenker C. [Spleen biopsy: "pros and cons" or better "when and when not?"]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:879-885. [PMID: 33752245 DOI: 10.1055/a-1404-3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Due to the relatively high complication rate, the necessity of a spleen biopsy is controversially discussed. In establishing its indication, the clinical background and performed diagnostics must be considered. Based on the medical history, imaging procedures and sonographic course, different clinical scenarios are conceivable. The aim of this review is to describe the indications of splenic biopsy considering various clinical scenarios.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisziplinäres Ultraschallzentrum, UKGM Marburg und Philipps-Universität Marburg
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Schweiz
| | - Christian Görg
- Interdisziplinäres Ultraschallzentrum, UKGM Marburg und Philipps-Universität Marburg
| | - Tobias Bleyl
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, UKGM Marburg und Philipps-Universität Marburg
| | - Amjad Alhyari
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, UKGM Marburg und Philipps-Universität Marburg
| | - Andre Ignee
- Department für Innere Medizin, Caritas Hospital, Bad Mergentheim, Germany
| | - Christian Jenssen
- Department für Innere Medizin, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Brandenburg Institute for Clinical Ultrasound at Medical Universitäy Brandenburg, Neuruppin, Germany
| | - Corinna Trenker
- Klinik für Hämatologie, Onkologie und Immunologie, UKGM Marburg und Philipps-Universität Marburg
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Karakuchi N, Yanagawa S, Takei D, Kodama S, Takeshima Y, Sumimoto K. A Case of Peritoneal Dissemination and Splenic Metastasis after Gastric Cancer Surgery That Could Be Controlled with Multidisciplinary Treatment. Case Rep Oncol 2020; 13:1164-1170. [PMID: 33173480 PMCID: PMC7590754 DOI: 10.1159/000510406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022] Open
Abstract
Splenic metastasis is known to occur at the terminal stage of cancer. While peritoneal dissemination is the most frequent recurrence of gastric cancer, metastasis to the spleen from gastric cancer is very rare. Splenectomy is currently the most effective probable treatment for solitary splenic metastasis of gastric cancer; it provides a good patient prognosis. However, careful consideration of surgical indications is required, as splenic metastasis is typically accompanied by multi-organ metastasis and dissemination. One of the main cancer treatment methods is the “wait-and-see” approach using chemotherapy. In general, patients with gastric cancer are treated with systemic chemotherapy for distant metastases including peritoneal dissemination. Radiotherapy is not commonly used to prolong life in patients with gastric cancer as gastric cancer is predominantly adenocarcinoma. However, a recent report indicated that chemo-radiotherapy was performed successfully for unresectable gastric cancer, including peritoneal dissemination. Here, we present the case of a 67-year-old patient who was observed to have peritoneal dissemination and splenic metastasis after gastric cancer surgery. Once the peritoneal dissemination was localized, surgical excision and chemo-radiotherapy were performed. We treated the splenic metastasis with the “wait-and-see” strategy with chemotherapy. A complete response on imaging in accordance with the Response Evaluation Criteria in Solid Tumors was achieved using multidisciplinary treatment. Our strategy of intensive multidisciplinary therapy could be a treatment option for cases with peritoneal dissemination or splenic metastasis of gastric cancer.
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Affiliation(s)
- Nozomi Karakuchi
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | | | - Daisuke Takei
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Shinya Kodama
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Sumimoto
- Department of Surgery, Yoshida General Hospital, Akitakata City, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Obana A, Komatsu N, Aiba K, Nakanishi S, Abe M, Yamaguchi T, Hayashi M, Obi H, Koyama M, Hashimoto S. A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer. World J Surg Oncol 2020; 18:250. [PMID: 32950063 PMCID: PMC7502201 DOI: 10.1186/s12957-020-02024-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Ayato Obana
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan. .,Department of General Surgery, Kashiwa Kousei General Hospital, 617, Shikoda, Kashiwa, Chiba, 277-8551, Japan.
| | - Nobuo Komatsu
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Kazuma Aiba
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Shinya Nakanishi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Masakazu Abe
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | | | - Masahiro Hayashi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Hayato Obi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Masamichi Koyama
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Shinichi Hashimoto
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
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Okada H, Ouchi K, Saito T, Takahashi Y, Yamada M, Negami N, Ishido Y, Yamazaki S, Sato M. Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review. Surg Case Rep 2020; 6:185. [PMID: 32728980 PMCID: PMC7391455 DOI: 10.1186/s40792-020-00955-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background The occurrence of sarcoid reactions has been recognized in various cancers. The common location for observing these granulomas is mainly the lymph nodes, but a rare occurrence in the spleen has been reported. Almost all splenic sarcoid reactions associated with gastric cancer have been resected synchronously and diagnosed accidentally, and a rare metachronous occurrence of a sarcoid reaction in the spleen after distal gastrectomy can mimic cancer metastasis. We describe a rare case of a splenic sarcoid reaction recognized in a patient with gastric cancer 6 months after distal gastrectomy. Case presentation An 82-year-old man underwent laparoscopic distal gastrectomy for gastric cancer (T3N0M0, stage IIA). Six months after gastrectomy, CT and 18F-fluorodeoxyglucose (FDG)-PET/CT showed the appearance of a splenic mass. We diagnosed solitary splenic metastasis from gastric cancer and performed laparoscopic-assisted splenectomy. His splenic tumor was diagnosed as a sarcoid reaction by histopathological examination. Conclusion To our knowledge, this is the first report of a splenic sarcoid reaction recognized 6 months after distal gastrectomy for gastric cancer without any chemotherapy. The splenic sarcoid reaction and cancer metastasis to the spleen were undistinguishable from the CT and FDG-PET/CT findings. The present case and literature review showed that cases of splenic sarcoid reactions associated with gastric cancer can also be accompanied by the occurrence of these granulomas in lymph nodes. When the appearance of a solitary mass is observed in the spleen after resection of primary cancer, it is necessary to consider not only cancer metastasis but also sarcoid reactions. Retrospective histopathological confirmation of the existence of sarcoid reactions in lymph nodes from resected specimens might possibly avoid incorrect diagnosis and intervention.
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Affiliation(s)
- Haruhiko Okada
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan.
| | - Kazutomo Ouchi
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Tetsuya Saito
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Yuka Takahashi
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Masaki Yamada
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Naoki Negami
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Yasunori Ishido
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
| | - Sanae Yamazaki
- Department of Pathology, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Masahiko Sato
- Department of Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nisikawaguchi, Kawaguchi, Saitama, 332-8558, Japan
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Dragnev NC, Wong SL. Do we CARE about the quality of case reports? A systematic assessment. J Surg Res 2018; 231:428-433. [PMID: 30278963 DOI: 10.1016/j.jss.2018.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/16/2018] [Accepted: 07/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical case reports are important sources of information on the identification and treatment of new or rare diseases. The CAse REport (CARE) Statement and Checklist represents consensus-based guidelines for clinical case reports. How well case reports adhere to these guidelines is unknown. MATERIAL AND METHODS A systematic PubMed and OVID search was used to identify case reports on isolated splenic metastasis from 2007 to 2017 in English language journals. MeSH search terms included "(isolated splenic metastasis OR solitary splenic metastasis) AND case report." We retrieved 79 articles and 55 directly addressed the topic of interest. Each was scored dichotomously using the 13 categories with 36 item descriptors on the CARE checklist. RESULTS Of the 55 case reports, none fully followed the CARE guidelines; only 56.4% met 23 descriptors and none had more than 29 of 36 descriptors. Patient symptoms were not described in 40.0%, and in 47.3%, the abstract did not identify the main outcomes. All reports included patient's age and diagnostic methods. Most case reports reported the type of intervention (96.4%) and effect of the intervention (96.4%). None included patient-assessed outcomes or the patient's perspective. Only 49.1% included strengths and limitations of patient management, stating that the most effective treatment is unknown. CONCLUSIONS None of the case reports on isolated splenic metastasis completely followed the CARE guidelines. Most reports did cover diagnostic workup and therapeutic interventions and gave a summary of the literature. Higher quality case reports would be useful in facilitating recognition of rare disease processes and informing clinical practice.
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Affiliation(s)
| | - Sandra L Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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