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An Unusual Metastatic Site for Primary Lung Cancer: The Spleen
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An Unusual Metastatic Site for Primary Lung Cancer: The Spleen Andrea Belli, MD,a,* Giuseppe De Luca, MD,b Francesco Bianco, MD,a Silvia De Franciscis, MD,a Fabiana Tatangelo, MD,c Giovanni Maria Romano, MD,a Gaetano Rocco, MD, FRCSEdb a
Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy b 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 c Pathology Division, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy Received 26 August 2015; accepted 28 August 2015
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.
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 followup. 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
Journal of Thoracic Oncology
Vol. 11 No. 1: 128-129
from a large cell lung carcinoma (Fig. 2). At 16 months follow-up, the patient is free from disease. 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%1; however, fewer than 100 cases of isolated splenic metastases with *Corresponding author. Disclosure: The authors declare no conflict of interest. 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. E-mail: [email protected] ª 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved. ISSN: 1556-0864 http://dx.doi.org/10.1016/j.jtho.2015.08.005
January 2016
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Figure 2. (A) Microscopic appearance of a neoplastic nodule inside the pulpa splenica, e/e (magnification 4). (B) Higher magnification of solid neoplastic nests.
different origins (mainly from ovarian and colorectal cancer) have been reported in the literature.1 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.2 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.2 Furthermore, surgery can prevent symptomatic splenomegaly and potentially
life-threatening complications such as splenic rupture and splenic vein thrombosis.3
References 1. 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. 2. Dias AR, Pinto RA, Ravanini JN, et al. Isolated splenic metastasis from lung squamous cell carcinoma. World J Surg Oncol. 2012;10:10–24. 3. 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.
An Unusual Metastatic Site for Primary Lung Cancer: The Spleen Andrea Belli, MD,a,* Giuseppe De Luca, MD,b Francesco Bianco, MD,a Silvia De Franciscis, MD,a Fabiana Tatangelo, MD,c Giovanni Maria Romano, MD,a Gaetano Rocco, MD, FRCSEdb a
Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy b 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 c Pathology Division, Istituto Nazionale Tumori Fondazione G. Pascale–Istituto Di Ricovero e Cura a Carattere Scientifico, Naples, Italy Received 26 August 2015; accepted 28 August 2015
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.
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 followup. 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
Journal of Thoracic Oncology
Vol. 11 No. 1: 128-129
from a large cell lung carcinoma (Fig. 2). At 16 months follow-up, the patient is free from disease. 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%1; however, fewer than 100 cases of isolated splenic metastases with *Corresponding author. Disclosure: The authors declare no conflict of interest. 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. E-mail: [email protected] ª 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved. ISSN: 1556-0864 http://dx.doi.org/10.1016/j.jtho.2015.08.005
January 2016
Spleen as Primary Lung Cancer Metastasis Site
129
Figure 2. (A) Microscopic appearance of a neoplastic nodule inside the pulpa splenica, e/e (magnification 4). (B) Higher magnification of solid neoplastic nests.
different origins (mainly from ovarian and colorectal cancer) have been reported in the literature.1 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.2 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.2 Furthermore, surgery can prevent symptomatic splenomegaly and potentially
life-threatening complications such as splenic rupture and splenic vein thrombosis.3
References 1. 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. 2. Dias AR, Pinto RA, Ravanini JN, et al. Isolated splenic metastasis from lung squamous cell carcinoma. World J Surg Oncol. 2012;10:10–24. 3. 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.