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Tivadar BM, Dumitrascu T, Vasilescu C. A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved. J Clin Med 2024; 13:2362. [PMID: 38673636 PMCID: PMC11050850 DOI: 10.3390/jcm13082362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Fundeni Street No. 258, 022328 Bucharest, Romania; (B.M.T.); (C.V.)
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Zhao L, Sui M, Li J, Zhang K. Case report of isolated synchronous multiple splenic metastases from rectal cancer: A case report and brief review of the literature. Medicine (Baltimore) 2022; 101:e29613. [PMID: 35960045 PMCID: PMC9371491 DOI: 10.1097/md.0000000000029613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Linxian Zhao
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Mingxiu Sui
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jiannan Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Zhang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
- *Correspondence: Kai Zhang, Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, China (e-mail: )
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Kakiashvili E, Shakra IA, Karra N, Merei F, Bickel A, Ganam S, Khuri S, Bez M. Multiple metastases from colorectal cancer isolated to the spleen: a rare entity. Chirurgia (Bucur) 2021; 34. [DOI: 10.23736/s0394-9508.20.05109-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hu L, Zhu JY, Fang L, Yu XC, Yan ZL. Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review. World J Clin Cases 2020; 8:3320-3328. [PMID: 32874988 PMCID: PMC7441267 DOI: 10.12998/wjcc.v8.i15.3320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/27/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Isolated splenic metastasis is a rare clinical entity. Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.
CASE SUMMARY We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously, and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen (CEA) and positron emission tomography (PET). However, multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging. Then the patient underwent total laparoscopic splenectomy. Local tumor recurrence and splenic metastasis from colorectal cancer (CRC) were found by postoperative pathology. Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2, APC exon16 and TP53 exon6 missense mutations, but no mutations of NRAS, KRAF, EGFR, ERBB2, MET, MLH1, MSH2 and MSH6 were detected. Chemotherapy and target therapy were administered after multiple disciplinary team (MDT) consultation, and no tumor recurrence has been observed to date. We also reviewed the literature by conducting a search of the PubMed database using the following key words: CRC, splenic metastasis, isolated, and review. We identified 34 relevant papers, which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.
CONCLUSION Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery. In terms of overall survival and progression-free survival, MDT plays an important role in the entire process of disease management.
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Affiliation(s)
- Li Hu
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Ji-Yun Zhu
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lei Fang
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Xiu-Chong Yu
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Zhi-Long Yan
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
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Isolated Metachronous Splenic Metastasis from Colon Cancer: Possible Explanations for This Rare Entity. J Gastrointest Cancer 2019; 50:143-146. [PMID: 28733788 DOI: 10.1007/s12029-017-9992-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lucke-Wold B, Bonasso PC, Turner R, Cassim R. Adenocarcinoma of the Cecum with Rare Splenic Metastasis. THE WEST VIRGINIA MEDICAL JOURNAL 2017; 113:32-34. [PMID: 28579648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Isolated splenic metasisis is a rare finding in colorectal carcinoma. We report a case of metastatic cecal adenocarcinoma to the spleen. In spring 2011, a 53-yearold woman underwent en bloc right hemicolectomy with partial omentectomy. The tumor was Stage III pT3 pN2a M0. She received four months of modified FOLFOX6 chemotherapy and one month of capecitabine. In spring 2012, a PET/CT revealed a low attenuation focus in the spleen consistent with metastatic adenocarcinoma, so she underwent splenectomy. Additional imaging has revealed no disease recurrence. There are only a small number of case reports for isolated splenic metastasis; thus, no standardized treatment course has been developed.
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Affiliation(s)
- Brandon Lucke-Wold
- Depts. of Surgery & Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
| | - Patrick C Bonasso
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Ryan Turner
- Depts. of Surgery & Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
| | - Riaz Cassim
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV
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Avninder S, Bhatnagar A, Agrawal U, Saxena S. Isolated splenic metastasis from colorectal mucinous carcinoma. ACTA ACUST UNITED AC 2012; 37:98-101. [PMID: 17827530 DOI: 10.1007/s12029-007-0007-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 01/09/2023]
Abstract
Metastatic tumors of the spleen are rare and occur in the presence of disseminated visceral metastasis. Isolated splenic metastases from colorectal carcinoma are rare and only 19 cases have been reported in English literature. We report a case of isolated splenic metastasis in a 52-year-old man, occurring 9 years after the primary colorectal mucinous carcinoma was treated by anterior resection. The patient underwent splenectomy along with adjuvant chemotherapy and is alive and asymptomatic at 22 months follow-up.
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Affiliation(s)
- Singh Avninder
- Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi, 110029, India.
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Abi Saad GS, Hussein M, El-Saghir NS, Termos S, Sharara AI, Shamseddine A. Isolated splenic metastasis from colorectal cancer. Int J Clin Oncol 2011; 16:306-313. [PMID: 21258837 DOI: 10.1007/s10147-010-0182-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/23/2010] [Indexed: 12/16/2022]
Abstract
Splenic metastases are unusual, arising in less than 1% of all metastases. Isolated solitary splenic metastasis from colorectal carcinoma is considered exceptional. This rarity has been explained by several hypotheses relating to the anatomical, histological, and immunological features of the spleen. We review the reported cases of isolated solitary splenic metastasis from colorectal carcinoma and discuss the diagnostic and therapeutic options for this entity. We searched the English-language medical literature, using the Medline and Pubmed databases from January 1966 through July 2010, for articles reporting isolated splenic metastasis from colorectal carcinoma. Only 26 cases have been reported; four cases had synchronous splenic metastasis. Fifteen patients had regional lymph node involvement on diagnosis of primary carcinoma. The primary tumor was located in the left colon or in the rectum in 18 cases. Carcinoembryonic antigen (CEA) level was elevated in 73% of cases. All patients underwent curative splenectomy; only one patient had laparoscopic resection of the spleen. Mean reported survival interval was 19.5 months; only three patients were deceased at last follow-up. Solitary splenic metastasis from colorectal carcinoma is very rare; clinicians are advised to pay close attention when routinely evaluating patients with serial CEA levels and abdominal scans. Splenectomy seems to be the preferred treatment modality with improvement of long-term survival. However, definitive conclusions cannot be drawn from the small number of case reports available.
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Affiliation(s)
- George S Abi Saad
- Department of Surgery, American University of Beirut Medical Center, Riad el Solh, Beirut, Lebanon.
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Wang J, Zhang BL, Guo DZ, Yuan QX. Clinical and pathological features of splenic metastases of colorectal carcinoma: an analysis of three cases. Shijie Huaren Xiaohua Zazhi 2011; 19:318-320. [DOI: 10.11569/wcjd.v19.i3.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinicopathological features and diagnosis of splenic metastases of colorectal carcinoma.
METHODS: The clinical data for three patients with splenic metastases of colorectal carcinoma were retrospectively analyzed to investigate the clinical features, methods of diagnosis and treatment, and prognosis of the disease.
RESULTS: A definite diagnosis was achieved preoperatively by PET/CT in one patient. Two patients were initially diagnosed with splenic abscess. Splenectomy was performed in two patients, and exploratory laparoscopy in one patient. One patient died 2 wk after operation, and the other two patients survived for 2 and 6 years, respectively.
CONCLUSION: Splenic metastases of colorectal carcinoma are a rare disease that is frequently misdiagnosed. Imaging examination is helpful in diagnosing splenic metastases of colorectal carcinoma. Patients with splenic abscess should be suspected of having concomitant colorectal carcinoma. Long-term survival can be achieved by splenectomy in colorectal carcinoma patients with isolated splenic metastasis.
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10
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Shieh TY, Wang TE, Shih SC, Chang WH, Chan YJ, Bair MJ. Synchronous Isolated Distant Metastasis to Spleen From Colon Adenocarcinoma. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(10)70007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sileri P, D'Ugo S, Benavoli D, Stolfi VM, Palmieri G, Mele A, Gaspari AL. Metachronous splenic metastasis from colonic carcinoma five years after surgery: a case report and literature review. South Med J 2009; 102:733-5. [PMID: 19487993 DOI: 10.1097/smj.0b013e3181a93c39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Metastatic lesions of the spleen are a rare finding and are generally associated with widespread disease. Moreover, solitary metastases of the spleen are exceptional. In this paper, we describe the case of a patient who developed an isolated splenic metastasis from colon carcinoma five years after surgery, and was successfully treated by splenectomy. We also review the scant literature experience discussing clinical diagnosis and approaches to this uncommon event.
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Affiliation(s)
- Pierpaolo Sileri
- From the Departments of Surgery and Pathology, University of Rome Tor Vergata, Rome, Italy
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12
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Adeyemo D, Hutchinson R. Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT. Colorectal Dis 2009; 11:259-63. [PMID: 18513197 DOI: 10.1111/j.1463-1318.2008.01588.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the quality of preoperative magnetic resonance imaging (MRI) staging of rectal cancer, and the clinical significance of abdomen and pelvic computed tomogram (CT) scans in preoperative staging of rectal cancer in a district general hospital. We postulated that the 'metastatic yield' of extrahepatic abdominal imaging is poor, and rarely altered management of rectal cancer. METHODS This is a retrospective study of preoperative MRI, CT scans and postoperative histology results of patients who had definitive surgery for rectal cancer at the Mid-Staffordshire General Hospitals NHS Trust over a 36-month period. Preoperative multiplanar pelvic MRI locoregional staging was compared with eventual histology. The incidence of and significance of abdomen and pelvic CT detected pathology (including metastasis) in the management of rectal cancers was also assessed. RESULTS Preoperative pelvic MRI correctly predicted 'clear' Circumferential resection margins, in 28 of 29 patients who had primary surgery. This is comparable with many published studies. Significant CT detected pathology (including metastasis) on preoperative abdomen and pelvic CT scans was uncommon, and did not influence management of any rectal cancer patient in our study. DISCUSSION Given that exclusive CT detected significant pathology caudal to the liver (extrahepatic abdomen) is rare, can full abdomen and pelvic CT scans be justified for preoperative staging of rectal cancers? - especially where chest X rays are employed for lung staging. Preoperative thoracic and upper abdomen CT scan may be a more productive use of resources. Full abdominal scans may be more appropriate for selection of rectal cancer patients with isolated liver metastasis for metastasectomy.
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Affiliation(s)
- D Adeyemo
- University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK.
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13
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Clinical case report and literature review: metachronous colorectal splenic metastases. Clin Transl Oncol 2008; 10:445-7. [PMID: 18628076 DOI: 10.1007/s12094-008-0230-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies.
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14
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Montemurro S, Maselli E, Ruggieri E, Caliandro C, Rucci A, Zito AF, Sciscio V. Isolated splenic metastasis from colon cancer. Report of a case. TUMORI JOURNAL 2008; 94:422-5. [PMID: 18705414 DOI: 10.1177/030089160809400322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Isolated splenic metastasis is an uncommon event, except in the case of secondary involvement by lymphoma. The most common sites of metastases of colorectal cancer are the regional lymph nodes, liver and peritoneum; lung and bone are rarely involved, the spleen exceptionally. In this paper we report a case of metachronous isolated splenic metastasis of transverse colon cancer in an 80-year-old woman who was successfully treated by splenectomy. The peculiar clinical-pathological aspects of this kind of metastasis are discussed on the basis of our clinical observation and a review is presented of similar cases reported in the literature. Only 14 reported cases of isolated splenic metastasis from colorectal cancer were found in Medline.
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Affiliation(s)
- Severino Montemurro
- Department of Surgical Oncology, National Cancer Institute Giovanni Paolo II, Bari, Italy.
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15
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Pisanu A, Ravarino A, Nieddu R, Uccheddu A. Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: A case report and review of the literature. World J Gastroenterol 2007; 13:5516-20. [PMID: 17907299 PMCID: PMC4171290 DOI: 10.3748/wjg.v13.i41.5516] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.
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Affiliation(s)
- Adolfo Pisanu
- Clinica Chirurgica, Università degli Studi di Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, Cagliari 09124, Italy.
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16
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Abstract
Solitary splenic lesions are unusual. A differential diagnosis can be organized around their basic imaging appearance as either predominantly cystic or solid. Other imaging characteristics, including vascular enhancement and activity on Tc-99m sulfur colloid scan, as well as clinical history may narrow the diagnostic possibilities. Cystic lesions include post-traumatic, inflammatory and infectious pseudocysts, congenital cysts, lymphangiomas and cystic metastasis. Solid lesions include both nonneoplastic lesions such as splenic hamartoma, benign tumors such as hemangioma and malignant masses including lymphoma and angiosarcoma. Percutaneous biopsy may be used for histologic diagnosis when required.
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Affiliation(s)
- David M Warshauer
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7510, USA.
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17
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Gencosmanoglu R, Aker F, Kir G, Tozun N. Isolated metachronous splenic metastasis from synchronous colon cancer. World J Surg Oncol 2006; 4:42. [PMID: 16824207 PMCID: PMC1526733 DOI: 10.1186/1477-7819-4-42] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 07/06/2006] [Indexed: 11/10/2022] Open
Abstract
Background Isolated splenic metastases from colorectal cancer are very rare and there are only 13 cases reported in the English literature so far. Most cases are asymptomatic and the diagnosis is usually made by imaging studies during the evaluation of rising CEA level postoperatively. Case presentation A 76-year-old man underwent an extended left hemicolectomy for synchronous colon cancers located at the left flexure and the sigmoid colon. The tumors were staged as IIIC (T3N2M0) clinically and the patient received adjuvant chemotherapy. During the first year follow-up period, the patient remained asymptomatic with normal levels of laboratory tests including CEA measurement. However, a gradually rising CEA level after the 14th postoperative month necessitated further imaging studies including computed tomography of the abdomen which revealed a mass in the spleen that was subsequently confirmed by 18FDG- PET scanning to be an isolated metastasis. The patient underwent splenectomy 17 months after his previous cancer surgery. Histological diagnosis confirmed a metastatic adenocarcinoma with no capsule invasion. After an uneventful postoperative period, the patient has been symptom-free during the one-year of follow-up with normal blood CEA levels, although he did not accept to receive any further adjuvant therapy. To the best of our knowledge, this 14th case of isolated splenic metastasis from colorectal carcinoma is also the first reported case of splenic metastasis demonstrated preoperatively by 18FDG PET-CT fusion scanning which revealed its solitary nature as well. Conclusion Isolated splenic metastasis is a rare finding in the follow-up of colorectal cancer patients and long-term survival can be achieved with splenectomy.
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Affiliation(s)
- Rasim Gencosmanoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
- Unit of Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | - Fugen Aker
- Department of Pathology, Haydarpasa State Hospital, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Umraniye State Hospital, Istanbul, Turkey
| | - Nurdan Tozun
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Avesani EC, Cioffi U, De Simone M, Botti F, Carrara A, Ferrero S. Synchronous isolated splenic metastasis from colon carcinoma. Am J Clin Oncol 2001; 24:311-312. [PMID: 11404507 DOI: 10.1097/00000421-200106000-00021] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report the first case known to us of a synchronous isolated splenic metastasis from colon carcinoma in a 52-year-old woman operated on splenectomy, left colectomy, and ileal resection. The patient died of diffuse carcinomatosis 1 year after the operation. Splenectomy for isolated splenic metastasis from colon carcinoma is justified, and serum tumor markers are useful to detect metastases early during the follow-up, as in our report.
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Affiliation(s)
- E C Avesani
- Department of Surgery, University of Milan, Italy
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19
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Place RJ. Isolated Colon Cancer Metastasis to the Spleen. Am Surg 2001. [DOI: 10.1177/000313480106700515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Splenic metastases from colon carcinoma are rare. If present they generally occur in concert with disseminated disease. Six cases have been previously reported. The patient presented here is a 51-year-old black man who presented with an enterocutaneous fistula as a complication from prior pelvic radiation. Workup included an abdominal CT and needle biopsy, which confirmed the splenic metastasis from a sigmoid colon cancer 6 years after the original diagnosis. The patient had an unevenful splenectomy. Although no long-term follow-up data are as yet available splenectomy including removal of hilar lymph nodes appears to be the treatment of choice. A case report and review of the literature are presented.
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Affiliation(s)
- Ronald J. Place
- Colon and Rectal Surgery Section, Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington
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