Isolated splenic metastasis from colorectal carcinoma in a high risk patient: a case report [Izolirana metastaza kolorektalnog karcinoma u slezenu u visokorizičnog bolesnika: prikaz slučajeva]

Pavlović, Mirjana and Šeparović, Robert and Vukelić-Marković, Mirjana and Patrlj, Leonardo and Kolovrat, Marijan and Kopljar, Mario and Babić, Nenad and Košuta, Dragutin and Babić, Žarko (2011) Isolated splenic metastasis from colorectal carcinoma in a high risk patient: a case report [Izolirana metastaza kolorektalnog karcinoma u slezenu u visokorizičnog bolesnika: prikaz slučajeva]. Collegium Antropologicum, 35 (4). pp. 1307-1310. ISSN 0350-6134

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Abstract

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made.

Abstract in Croatian

Izolirane metastaze kolorektalnog karcinoma u slezenu su rijetkost. U članku prezentiramo slučaj 74-godišnjeg muškarca s poznatom anamnezom dijabetesa tipa II i paroksizmalne fibrilacije atrija, kojemu je, u kolovozu 2004. godine, učinjena desnostrana hemikolektomija zbog adenokarcinoma cekuma. U lipnju 2007. godine bolesniku je dijagnosticirana teška aortalna stenoza, kao i dugopotezna stenoza prve marginalne grane lijeve koronarne arterije. Predložena mu je operacija zamjene aortnog zaliska uz aortokoronarno premoštenje, no odbio je operativni zahvat. U listopadu 2007. godine bolesniku je, zbog porasta vrijednosti serumskog CEA, učinjen 18FDG – PET sken koji je pokazao 5 cm veliku izoliranu hipermetaboličku leziju u slezeni. Slučaj je prezentiran kirurzima koji se, zbog komorbiditeta i operativnog rizika, nisu odlučili za zahvat splenektomije. Provedena je kemoterapija kapecitabinom u 8 ciklusa nakon čega su vrijednosti serumskog CEA ponovno počele rasti, a kontrolni MSCT je pokazao progresiju veličine metastaze. Tim stručnjaka je reevaluirao cijeli slučaj te je u rujnu 2008. godine bolesniku učinjena splenektomija. U svibnju 2009. godine, tijekom postoperativnog praćenja, kontrolni MSCT je pokazao uvećane limfne čvorove u celijačnoj regiji i suspektnu jetrenu metastazu nakon čega je bolesnik hospitaliziran na daljnje kemoterapijsko liječenje. Još uvijek ne postoji standardizirano liječenje predviđeno za ovakve bolesnike zahvaljujući malom broju slučajeva koji su opisani u literaturi. Splenektomija praćena kemoterapijom je vjerojatno optimalan slijed liječenja, ali konačni zaključci, odnosno smjernice liječenja, se još ne mogu donijeti.

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