A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer

Abstract

Background Very rarely does a splenic solitary metastasis arise from a gastric carcinoma because splenic metastasis is usually seen in association with widespread visceral metastasis. Splenectomy is considered to be a curative treatment; however, long-term prognosis after splenectomy has scarcely been reported. We report a case of a metachronous and solitary metastasis to the spleen from gastric cancer in which the patient achieved 5-year recurrence-free survival after splenectomy. Case presentation An 84-year-old man underwent an open total gastrectomy involving D1+ lymph nodes dissection for gastric cancer located in the cardia (pT3N1M0, pStage IIB). Eighteen months later, a 2-cm solitary hypodense lesion was detected in the spleen by computed tomography (CT). Twenty-three months later, the serum carcinoembryonic antigen (CEA) value elevated to 19.9 ng/ml, and abdominal CT revealed an increase in tumor size to 5 cm. Positron-emission tomography (PET)-CT revealed intense 18F-2-deoxy-2-fluoro-glucose (FDG) uptake in the spleen without the involvement of other organs and lymph nodes. We diagnosed him with solitary splenic metastasis from gastric cancer and performed a splenectomy 26 months after the first surgery. Histological examination revealed that the splenic tumor was a moderately differentiated adenocarcinoma, which was very similar to the primary gastric tumor; the lesion was diagnosed as a metastatic tumor from the previous gastric carcinoma. The patient remains healthy to date without recurrence, 5 years after the splenectomy. Conclusion We experienced a case of a solitary splenic metastasis from gastric cancer in which 5-year recurrence-free survival was achieved after splenectomy. To determine the surgical indication in patients with splenic metastasis, it is important to differentiate between a solitary lesion or multiple metastasis. Especially, occult metastasis should be excluded by means of several months of follow-up with imaging tests and systemic FDG-PET surveys before splenectomy.

Minimally Invasive Conversion Surgery for Unresectable Gastric Cancer with Splenic Metastasis and Splenic Vein Tumor Thrombus: A Case Report

“…In our patient with gastric cancer, two important issues were highlighted: splenic metastasis and SVTT. Because splenic metastasis of gastric cancer is usually associated with peritoneal dissemination or multiple visceral metastases, there are few reports of resection for solitary splenic metastasis [17]. Despite the anatomical proximity between the stomach and spleen, splenic metastasis of gastric cancer is rare.…”

“…A study of 93 cases of solitary splenic metastasis reported that in 7.5% of cases, gastric cancer metastasis occurred [18]. Gastric cancer causes splenic metastasis through three pathways: (1) via the lymphatic route, (2) via the splenic vein, and (3) via the splenic artery [17]. The spleen has a poorly developed lymphatic system and few afferent lymphatic vessels.…”

“…However, it is also true that in some of these cases, long-term survival can be achieved with multimodality treatment involving radical resection [17,20,21,23]. To our knowledge, there is only one prior reported case of R0 surgery performed in a patient with splenic metastasis and a tumor thrombus of the portal system [24].…”

Splenic hemangiomas with different imaging findings: two laparoscopically resected incidentalomas

“…In case 2, we suspected a metastatic tumor derived from adenocarcinoma of the ascending colon because of both the patient's medical history and the rapid enlargement of the tumor. Solitary splenic metastases are rare, but they can occur in some cases (13). It may have been better to perform a biopsy of the tumor.…”

Isolated splenic metastasis of endometrial cancer 12 years after treatment

“…[2] Metastases to the spleen from solid cancers are uncommon, with a prevalence of 2.3% to 7.1%. [3] Although splenic metastasis arises from gastric cancer, colorectal cancer, lung cancer, nasopharyngeal carcinoma, ovarian cancer, breast cancer, and other types of cancer, [4][5][6][7][8] isolated splenic metastasis from endometrial adenocarcinoma is extremely rare. To date, only 17 such cases have been reported in the literature.…”