Advertisement

An Unusual Metastatic Site for Primary Lung Cancer: The Spleen

  • Andrea Belli
    Correspondence
    Corresponding author. Address for correspondence: Andrea Belli, MD, Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy.
    Affiliations
    Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Giuseppe De Luca
    Affiliations
    Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Francesco Bianco
    Affiliations
    Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Silvia De Franciscis
    Affiliations
    Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Fabiana Tatangelo
    Affiliations
    Pathology Division, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Giovanni Maria Romano
    Affiliations
    Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
  • Gaetano Rocco
    Affiliations
    Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy
    Search for articles by this author
      A 65-year-old man who had undergone a right pneumonectomy for a pT2bN0M0 large cell carcinoma 5 years earlier was referred to our institution for evaluation of a splenic nodule detected during regular follow-up. The patient was asymptomatic and his physical examination and laboratory tests were unremarkable. A total-body computed tomography scan revealed an isolated approximately 5-cm splenic mass (Fig. 1A). No other uncommon findings were reported. Positron emission tomography–computed tomography demonstrated high accumulation of 18F-fluorodeoxyglucose in the splenic mass with a maximal standardized uptake value of 22.4 and no evidence of metabolically active lymphadenopathy or other parenchymal masses (Fig. 1B). The patient underwent a splenectomy with a high epidural block. The histological evaluation confirmed the suspicion of isolated splenic metastases from a large cell lung carcinoma (Fig. 2). At 16 months follow-up, the patient is free from disease.
      Figure thumbnail gr1
      Figure 1(A) Computed tomography scan demonstrating a solid splenic mass and the postpneumonectomy sequelae. (B) Positron emission tomography scan highlighting the unique site of uptake in the spleen.
      Figure thumbnail gr2
      Figure 2(A) Microscopic appearance of a neoplastic nodule inside the pulpa splenica, e/e (magnification ×4). (B) Higher magnification of solid neoplastic nests.
      Splenic metastases from solid tumors are rare and usually occur in association with disseminated disease. In the reported autopsy series, the rate of spleen metastases varied widely between 2.3% and 7.1%
      • Comperat E.
      • Bardier-Dupas A.
      • Camparo P.
      • et al.
      Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis.
      ; however, fewer than 100 cases of isolated splenic metastases with different origins (mainly from ovarian and colorectal cancer) have been reported in the literature.
      • Comperat E.
      • Bardier-Dupas A.
      • Camparo P.
      • et al.
      Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis.
      Solitary splenic metastases from primary lung cancer is extremely rare, and to the best of our knowledge, only nine cases with a metachronous appearance have been reported in the English-language literature.
      • Dias A.R.
      • Pinto R.A.
      • Ravanini J.N.
      • et al.
      Isolated splenic metastasis from lung squamous cell carcinoma.
      When a neoplastic lesion of the spleen is suspected, a detailed staging is mandatory to exclude occult systemic disease. Although no guidelines for the surgical treatment of isolated splenic metastasis are available at present, the survival time after splenectomy ranges between 1 and 49 months, with one patient still alive after 8 years.
      • Dias A.R.
      • Pinto R.A.
      • Ravanini J.N.
      • et al.
      Isolated splenic metastasis from lung squamous cell carcinoma.
      Furthermore, surgery can prevent symptomatic splenomegaly and potentially life-threatening complications such as splenic rupture and splenic vein thrombosis.
      • Pugalenthi A.
      • Bradley C.
      • Gonen M.
      • et al.
      Splenectomy to treat splenic lesions: an analysis of 148 cases at a cancer center.

      References

        • Comperat E.
        • Bardier-Dupas A.
        • Camparo P.
        • et al.
        Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis.
        Arch Pathol Lab Med. 2007; 131: 965-969
        • Dias A.R.
        • Pinto R.A.
        • Ravanini J.N.
        • et al.
        Isolated splenic metastasis from lung squamous cell carcinoma.
        World J Surg Oncol. 2012; 10: 10-24
        • Pugalenthi A.
        • Bradley C.
        • Gonen M.
        • et al.
        Splenectomy to treat splenic lesions: an analysis of 148 cases at a cancer center.
        J Surg Oncol. 2013; 108: 521-525