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Critical Commentary
Critical Commentary to Unusual Vascular Changes in the Red Pulp of the Spleen Accompanying Breast Carcinoma Metastatis by F. Chapel et al. (in: Pathol. Res. Pract. 195: 53-56, 1999)
P. Rudolph, Kiel, Germany
Chapel et al. present an unusual and informative case of occult breast carcinoma metastatic to the spleen. The leading symptom was anemia apparently due to hypersplenism. Splenectomy revealed a slightly enlarged firm spleen with a homogeneously pale surface and a slightly thickened capsule. The hilar fatty tissue also appeared enlarged and sclerotic. Microscopically, the parenchyma of the spleen and the hilar fat as well as a parahilar lymph node were infiltrated by small cells distributed diffusely or in a nodular or linear array throughout all compartments of the splenic tissue. The tumor cells occasionally contained small PAS-positive cytoplasmic vacuoles and consistently expressed cytokeratin, epithelial membrane antigen, and estrogen as well as progesterone receptors, which strongly suggests the diagnosis of metastatic mammary carcinoma. Tumor cell infiltration was accompanied by extensive fibrosis and widespread sinus thrombosis with old and fresh hemorrhage. Further examinations disclosed axillar lymph node metastases and discrete carcinosis of the bone marrow with concomitant myeolofibrosis. The cytopeny was rapidly corrected by the splenectomy, and the patient is reported to be alive and well under tamoxifen therapy. The authors point out that carcinoma metastasis to the spleen is rare, and in most instances an incidental finding at autopsy. The present case is remarkable in
Pathol. Res. Pract. 195: 57 (1999)
that it led to the discovery of an unsuspected carcinoma of the breast. The pathways of carcinoma metastasis with spleen involvement are briefly discussed. Differential diagnoses, notably the possible confusion with malignant lymphoma, are concisely contemplated. A major part of the discussion is concerned with the peculiar stromal reaction. Although the authors take into consideration that this might be secondary to thrombosis provoked by coagulation disorders occasionally associated with various types of neoplasia, they conclude on the basis of a careful evaluation of the morphological findings that more likely than not a desmoplastic reaction caused by cytokine secretion from the tumor cells eventually entailed the strikingly widespread thromboses. This is a well written and informative paper. The methods are in line with the current state of art, the results are clearly and thoroughly presented, well illustrated, and comprehensively discussed. My only objection concerns the statement that "...tumor cells were invading the red pulp...". Histopathology can only describe a momentary state but allows no insight into a dynamic process. Address for correspondence: Dr. P. Rudolph, Institut fUr Hamatologie, Zentrum Pathologie und Angewandte Krebsforschung, Niemannsweg 11, D - 24105 Kiel, Germany.
0344-0338/99/195/1-057 $12.00/0
P. Rudolph, Kiel, Germany
Chapel et al. present an unusual and informative case of occult breast carcinoma metastatic to the spleen. The leading symptom was anemia apparently due to hypersplenism. Splenectomy revealed a slightly enlarged firm spleen with a homogeneously pale surface and a slightly thickened capsule. The hilar fatty tissue also appeared enlarged and sclerotic. Microscopically, the parenchyma of the spleen and the hilar fat as well as a parahilar lymph node were infiltrated by small cells distributed diffusely or in a nodular or linear array throughout all compartments of the splenic tissue. The tumor cells occasionally contained small PAS-positive cytoplasmic vacuoles and consistently expressed cytokeratin, epithelial membrane antigen, and estrogen as well as progesterone receptors, which strongly suggests the diagnosis of metastatic mammary carcinoma. Tumor cell infiltration was accompanied by extensive fibrosis and widespread sinus thrombosis with old and fresh hemorrhage. Further examinations disclosed axillar lymph node metastases and discrete carcinosis of the bone marrow with concomitant myeolofibrosis. The cytopeny was rapidly corrected by the splenectomy, and the patient is reported to be alive and well under tamoxifen therapy. The authors point out that carcinoma metastasis to the spleen is rare, and in most instances an incidental finding at autopsy. The present case is remarkable in
Pathol. Res. Pract. 195: 57 (1999)
that it led to the discovery of an unsuspected carcinoma of the breast. The pathways of carcinoma metastasis with spleen involvement are briefly discussed. Differential diagnoses, notably the possible confusion with malignant lymphoma, are concisely contemplated. A major part of the discussion is concerned with the peculiar stromal reaction. Although the authors take into consideration that this might be secondary to thrombosis provoked by coagulation disorders occasionally associated with various types of neoplasia, they conclude on the basis of a careful evaluation of the morphological findings that more likely than not a desmoplastic reaction caused by cytokine secretion from the tumor cells eventually entailed the strikingly widespread thromboses. This is a well written and informative paper. The methods are in line with the current state of art, the results are clearly and thoroughly presented, well illustrated, and comprehensively discussed. My only objection concerns the statement that "...tumor cells were invading the red pulp...". Histopathology can only describe a momentary state but allows no insight into a dynamic process. Address for correspondence: Dr. P. Rudolph, Institut fUr Hamatologie, Zentrum Pathologie und Angewandte Krebsforschung, Niemannsweg 11, D - 24105 Kiel, Germany.
0344-0338/99/195/1-057 $12.00/0