Isolated splenic metastasis from colon cancer: case report and literature review [Izolirana merastaza raka debelog crijeva u slezeni: prikaz slučajeva i pregled literature]

Bušić, Željko and Čupurdija, Kristijan and Kolovrat, Marijan and Čavka, Vlatka and Čavka, Mislav and Patrlj, Leonardo and Servis, Dražen and Kvesić, Ante (2010) Isolated splenic metastasis from colon cancer: case report and literature review [Izolirana merastaza raka debelog crijeva u slezeni: prikaz slučajeva i pregled literature]. Collegium Antropologicum, 34 (S. 1). pp. 287-290. ISSN 0350-6134

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Abstract

Solitary splenic metastases are very rare and sporadic. There are several explanations for this low incidence of splenic metastasis including anatomical, histological and immunological features of the spleen. In this paper we present a case of 70-year-old man with no history of previous diseases who was first operated under the diagnosis of acute abdomen revealing perforated colon tumor of splenic flexure with no metastases at that time. Left hemicolectomy was performed followed by postoperative complications demanding a subtotal colectomy and ileostomy. Primary tumor was classified as Dukes (Astler-Coller)-C2, T4N1M0. Patient was referred to oncologist and received chemotherapy (5FU, Leucovorin). 5 months later continuity of the gut was performed by ileosygmoanastomosis. 2 years after first surgical procedure, a CT scan and abdominal ultrasound, followed by needle biopsy, showed isolated metastasis in spleen, so splenectomy was performed. Pathological findings revealed sharply bordered, partially necrotic tumor inside of spleen tissue, spreading to, but not reaching splenic hilum. Histology showed low to medium differentiated adenocarcinoma tissue with desmoplastic stromal reaction. There were no protrusions of tumor cells through spleen surface. In splenic hilum 4 tumor free lymph nodes were harvested. No additional chemotherapy was conducted. The latest follow up, a year after diagnosis of metastasis showed no signs of cancer disease. Review of the literature showed that long term survival and prognosis of isolated splenic colorectal metastasis after splenectomy are rather optimistic, although these are the cases of distant metastasis. Due to small number of cases reported in literature, definitive conclusions and/or guidelines for the treatment of isolated splenic metastasis cannot be given, but splenectomy and chemotherapy are preferable in the treatment, promising long term survival at least for metachronous metastasis.

Abstract in Croatian

Izolirane metastaze u slezeni javljaju se vrlo rijetko i sporadično. Postoji nekoliko objašnjenja ove niske incidencije metastaza u slezeni, uključujući anatomske, histološke i imunološke osobine slezene. U ovom članku prezentirali smo slučaj 70-godišnjeg muškarca, koji ranije nije bolovao od težih bolesti, a koji je najprije operiran pod kliničkom slikom akutnog abdomena kada je otkriven perforirani tumor debelog crijeva u području lijenalne fleksure bez metastaza. Učinjena je lijeva hemikolektomija, a potom zbog poslijeopoeracijskih komplikacija subtotalna kolektomija i isleostoma. Primarni tumor klasificiran kao Dukes (Astler-Coller)-C2, T4N1M0. Pacijent je upućen onkologu te je primio kemoterapiju (5FU, Leucovorin). Pet mjeseci kasnije kontinuitet probavnog sustava uspostavljen je ileosigmoanastomozom. Dvije godine nakon prve operacije CT i ultrazvuk trbuha te punkcijska biopsija otkrili su izoliranu metastazu u slezeni te je učinjena splenektomija. Patološka analiza pokazala je da se radi o oštro ograničenom, djelomično nekrotičnom tumoru unutar tkiva slezene koji se širi prema, ali ne dopire do hilusa slezene. Histološka analiza pokazala je nisko do srednje diferenciran adenokarcinom sa dezmoplastičkom rekacijom strome. Nije nađena protruzija stanica tumora kroz površinu slezene. Iz hilusa slezene izolirana su 4 limfna čvora bez znakova tumorskog rasta. Dodatna kemoterapija nije provedena. Na zadnjem kontrolnom pregledu, godinu dana nakon dijagnoze metastaze, kod pacijenta nije nađena karcinomska bolest. Pregled literature ukazuje da je dugoročno preživljavanje bolesnika sa izoliranim metastazama raka debelog crijeva u slezeni nakon splenektomije moguće te prognoza prilično optimistična, iako su to zapravo slučajevi udaljenih metastaza. Zbog malog broja slučajeva opisanih u literaturi, definitivni zaključci i/ili smjernice za liječenje izoliranih metastaza raka debelog crijeva u slezeni ne mogu se donijeti ali su splenektomija i kemoterapija preporučljivi načini liječenja obećavajući dugoročno preživljenje, barem kod metakronih metastaza.

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