Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review

Clinicopathological Features and Prognoses of Patients With Splenic Metastases From Breast Cancer: A Single-Centre, Retrospective Study

PURPOSE

Splenic metastases (SM) from breast cancer (SMBC) are exceedingly rare. To date, the relevant literature is primarily based on pan-tumour species, with only a few studies exploring SM specifically in relation to breast cancer. As such, the present retrospective study explored the clinicopathological characteristics and prognoses of patients with SMBC at the breast care centre of the authors' hospital.

METHODS

Data from patients newly diagnosed with metastatic breast cancer (MBC) between June 2017 and June 2022 were extracted from medical records at the authors' hospital. Clinicopathological characteristics and their associations with progression-free survival (PFS [time from diagnosis of initial recurrence and/or metastasis to diagnosis of SM]), first overall survival (1stOS [time from diagnosis of breast cancer to death or last follow-up visit]), and second overall survival (2ndOS [time from diagnosis of SM to death or last follow-up visit]) were analysed in patients with SMBC.

RESULTS

In total, 1009 patients with MBC were identified, of whom 18 (1.7%) had SM. T1 and T2 stages were documented in 15 (83.3%) patients, whereas N2 and N3 were documented in 13 (62.2%). 14 (77.8%) patients were oestrogen receptor and/or progesterone receptor positive. A Ki-67 index ≥ 30% accounted for 72.2% (13/18) of cases, and all patients were histological grade II or III. Liver and/or lung metastases were documented in all 18 (100%) patients. Median PFS was 6.3 months. The median 1stOS and 2ndOS were 41.8 and 10.6 months, respectively. The number of previous treatment lines before diagnosis of SM was a significant adverse prognostic factor for PFS, and disease-free survival was a significant adverse prognostic factor for 1stOS.

CONCLUSION

SMBC commonly presents with diffuse multiple organ metastases in the terminal stage of malignancy and has a poor prognosis, which may provide deeper insight into SMBC for clinicians.

A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved

Background: Many papers exploring the role of resectioning metastases in colorectal cancer (CRC) have focused mainly on liver and lung sites, showing improved survival compared with non-resectional therapies. However, data about exceptional metastatic sites such as splenic metastases (SMs) are scarce. This paper aims to assess the role and effectiveness of splenectomy in the case of isolated metachronous SM of CRC origin. Methods: The patients' data were extracted after a comprehensive literature search through public databases for articles reporting patients with splenectomies for isolated metachronous SM of CRC origin. Potential predictors of survival were explored, along with demographic, diagnostic, pathology, and treatment data for each patient. Results: A total of 83 patients with splenectomies for isolated metachronous SM of CRC origin were identified. The primary CRC was at an advanced stage (Duke's C-70.3%) and on the left colon (45.5%) for most patients, while the median interval between CRC resection and SM was 24 months. The median overall survival after splenectomy was 84 months, and patients younger than 62 years presented statistically significantly worse overall survival rates than those ≥62 years old (p = 0.011). There was no significant impact on the long-term outcomes for factors including primary tumor location or adjuvant chemotherapy (p values ≥ 0.070, ns). Laparoscopic splenectomy was increasingly used in the last 20 years from 2002 (33.3% vs. 0%, p < 0.001). Conclusions: Splenectomy is the optimal treatment for patients with isolated metachronous SM of CRC, with the laparoscopic approach being increasingly used and having the potential to become a standard of care. Encouraging long-term survival rates were reported in the context of a multidisciplinary approach. Younger ages are associated with worse survival. Perioperative chemotherapy in the context of a patient diagnosed with SM of CRC origin appears to be a reasonable option, although the present study failed to show any significant impact on long-term survival.

Isolated splenic metastases from rectal carcinoma 5 years after surgery: Case report

INTRODUCTION

Splenic malignancies are mostly lymphocytic tumors and splenic metastases are rarer.[1] According to reports, the most common source of splenic metastases include melanoma, tumors of the breast, lung, ovary, colon, stomach, and pancreas.[2,3].

PATIENT CONCERNS

This paper reports a 41-year-old male patient who underwent a successful resection of low rectal cancer in our hospital 5 years ago.

DIAGNOSIS

Three months ago, computed tomography scan revealed a tumor in the spleen, considered as an isolated metastasis.

INTERVENTIONS

The patient underwent splenectomy and postoperative pathological examination confirmed metastatic adenocarcinoma.

OUTCOMES

The patient was followed up for 3 months after surgery, there was no abdominal metastasis or recurrence.

CONCLUSION

The splenic metastasis from rectal carcinoma 5 years after surgery is rare. If it is a solitary splenic metastasis, splenectomy can effectively improve the prognosis of patients. We review the literature and report this case.

Case report of isolated synchronous multiple splenic metastases from rectal cancer: A case report and brief review of the literature

INTRODUCTION

Isolated splenic metastasis emanating from colorectal cancer is an extremely rare finding, which usually indicates widely disseminated and multiple metastatic cancer. There have only been 39 cases of isolated splenic metastasis reported in the English literature to date.

PATIENT CONCERNS

An 84-year-old female patient presented to our department with dark-red bloody stool that had persisted for 1 month and with an increased serum carcinoembryonic antigen (CEA) level.

DIAGNOSES

A colonoscopy showed a rectal mass located 3 cm from the anal margin, which was 45 mm in diameter. The patient was diagnosed with rectal cancer with splenic metastases by abdomen computed tomography.

INTERVENTIONS

The patient underwent a radical resection of rectal cancer and splenectomy, and the postoperative histopathology confirmed that the splenic lesions were derived from the adenocarcinoma of the rectum.

OUTCOMES

After surgical treatment, the patient recovered well and was recommended for further chemotherapy.

CONCLUSIONS

In addition to revealing a rare case, we also performed a literature review, including a brief discussion about the atypical isolated splenic metastasis from colorectal cancer. Our findings enrich the database of this rare clinical entity and provide experience in the management of splenic metastasis.

Dihydropyrimidine dehydrogenase (DPYD) gene c.1627A>G A/G and G/G genotypes are risk factors for lymph node metastasis and distant metastasis of colorectal cancer

BACKGROUND

Dihydropyrimidine dehydrogenase (DPD) acts as the key enzyme catabolizing pyrimidines, and may affect the tumor progression. DPYD gene mutations affect DPD activity. The relationship between DPYD IVS14+1G>A, c.1627A>G, c.85T>C and lymph node metastasis (LNM) and distant metastasis (DM) of colorectal cancer (CRC) was investigated.

METHODS

A total of 537 CRC patients were enrolled in this study. DPYD polymorphisms were analyzed by polymerase chain reaction (PCR)-Sanger sequencing. The relationship between DPYD genotypes and clinical features of patients, metastasis of CRC was analyzed.

RESULTS

About DPYD c.1627A>G, A/A (57.7%) was the most common genotype, followed by A/G (35.6%), G/G (6.7%) genotypes. In c.85T>C, T/T, T/C, and C/C genotypes are accounted for 83.6%, 16.0%, and 0.4%, respectively. Logistic regression analysis revealed that DPYD c.1627A>G A/G and G/G genotypes in the dominant model (A/G + G/G vs. A/A) were significant risk factors for the LNM (p = 0.029, OR 1.506, 95% CI = 1.048-2.165) and DM (p = 0.039, OR 1.588, 95% CI = 1.041-2.423) of CRC. In addition, DPYD c.1627A>G polymorphism was more common in patients with abnormal serum carcinoembryonic antigen (CEA) (>5 ng/ml) (p = 0.003) or carbohydrate antigen 24-2 (CA24-2) (>20 U/ml) level (p = 0.015).

CONCLUSIONS

The results suggested that DPYD c.1627A>G A/G, G/G genotypes are associated with increased risk of LNM and DM of CRC.