Case Report: Unusual splenic mass in an elderly patient

Case Presentation

A 76-year-old female patient with history of recurrent adenocarcinoma of the colon. She underwent multiple segmental resection of her colon. (right hemicolectomy, re-ileocolic resection, total intra-abdominal colectomy) and received adjuvant chemotherapy (FOLFOX protocol for six months, six courses of FOLFIRI + AVASTIN, Immunotherapy). Six months after her last operation, new uptake in a routine PET-CT scan [figure 1] was detected in a large cystic lesion in the spleen. The patient was asymptomatic. No weight loss or pyrexia was noted. Colonoscopy was unremarkable.
Differential diagnosis:

1. Primary splenic lymphoma
2. Splenic metastasis of adenocarcinoma
3. Splenic abscess
4. Angiosarcoma of the spleen
5. Splenic trauma during previous surgery

Diagnosis

Splenic metastasis of adenocarcinoma.

Discussion

Splenic metastases from colo-rectal carcinoma (CRC) are very rare. To date, there are only 41 reported cases in the literature, with the majority being metachronous tumors [1]. Splenic CRC metastases generally occur in the presence of disseminated disease [2]. Many theories exist regarding the low incidence of splenic metastases from colon cancer. The sharp angulations of the splenic artery with its origin on the celiac trunk and the rhythmic contraction of the spleen have been proposed as two limiting factors [3]. Metastasis to the spleen should be considered if the patient has signs or symptoms of splenomegaly or a well-circumscribed lesion in CT scan or ultrasound. PET-CT imaging shows an isolated hypermetabolic lesion in the spleen[4]. Splenectomy may be justified in the presence of isolated splenic metastatic disease, since it is an operation with a low complication rate and is potentially curative [5].

Our patient had a very aggressive disease with several tumor recurrences after surgery and chemotherapy. Her very high uptake levels in PET-CT suggested a metabolically active process in her spleen. Although very uncommon, especially as an isolated lesion, the mass was suspected to be a metastasis and patient was taken to the operating room for splenectomy. Pathology of the spleen demonstrated a 5.5 cm metastatic moderately to poorly differentiated adenocarcinoma [figure 2]. Metastatic carcinoma was noted in four lymph nodes as well. The morphologic appearance of the carcinoma was similar to that of the biopsy from her previous surgery. The patient recovered well from the operation and was referred for adjuvant oncological treatment.

Article Info

Article Type

Case Report

Publication history

Received: Fri 30, Mar 2018
Accepted: Fri 20, Apr 2018
Published: Fri 11, May 2018

Copyright

© 2023 Abed Khalaileh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2018.10.005

Author Info

Abed Khalaileh Gail Amir Jonathan Zaga Jonathan B. Yuval Karine Atlan Max Sirota Pikarsky Alonj Yair Shachar

Corresponding Author

Abed Khalaileh
The Department of Surgery, Hadassah-Hebrew University Medical center, Ein Kerem, Jerusalem, Israel

Figures & Tables

Figure 1

Figure 2

Figure 3

Figure legends
Fig. 1: PET-CT showing solitary lesion with high uptake in the spleen

Fig. 2: Metastatic poorly differentiated adenocarcinoma (lower left corner) in spleen (S)

Fig. 3: Macroscopic view of the mass in the spleen

References

1. Adolfo Pisanu, Alberto Ravarino, Riccardo Nieddu, Alessandro Uccheddu (2007) Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: a case report and review of the literature. World J Gastroenterol 13: 5516-5520. [Crossref]

 

2. Place RJ (2001) Isolated colon cancer metastasis to the spleen. Am Surg 67: 454-457. [Crossref]

 

3. Morgenstern L, J Rosenberg, SA Geller (1985) Tumors of the spleen. World J Surg 9(3): 468-476.

 

4. Rasim Gencosmanoglu, Fugen Aker Gozde Kir, Nurdan Tozun (2006) Isolated metachronous splenic metastasis from synchronous colon cancer. World J Surg Oncol 4: 42. [Crossref]

 

5. Indudhara R, et al. (1997) Isolated splenic metastases from colon cancer. South Med J 90: 633-636.