A case of metachronous splenic metastasis from renal cell carcinoma after 14 years

Abstract

We present a case of a patient who developed a metachronous splenic metastasis from renal clear cell carcinoma, for which he has undergone a left nephrectomy 14 years earlier. During his routine follow up a CT scan showed a splenic mass which was considered an isolated metastasis possibly originating from the renal cancer. A splenectomy was performed and histopatological examination of the spleen confirmed the presence of clear cell carcinoma with infiltration of the capsule. Splenic metastases are uncommon and from the reported literature we understand that splenic metastasis from renal cell carcinoma is extremely rare. The optimal treatment seems to be splenectomy with a good long term outcome. With this report the authors would like to discuss the possibility that it could be a case of local recurrence rather than a real metastasis. A revision of previous reports in the literature is performed too.

Isolated splenic metastasis from clear cell renal carcinoma – A case report

“…The rhythmic contractions by splenic sinusoids and its physiological actions of phagocytosis and immunological antineoplastic action may be the factors preventing tumor seeding in spleen. The sharp angle of splenic artery with the coeliac axis may also prevent large tumor emboli from entering the artery [3], [4].…”

“…Single site metastasis is associated with better prognosis and surgery is the best treatment for an isolated lesion. Follow up is done with ultrasonography, CT, PET [4].…”

Solitary metastatic clear cell carcinoma to the spleen

“…5 Metastatic tumors to the spleen are also rare, and are usually undetected except on post-mortem studies or in patients with advanced or disseminated disease. 6,7,13,14 We report here a patient with a metastatic clear cell carcinoma to the spleen.…”

“…3–5,15 In each of these tissues, clear cell tumors are typically associated with aggressive metastatic behavior and poor clinical outcomes. However, clear cell pathology of other tissue types has been described.…”

“…Metastatic clear cells to the spleen are extremely rare, with only one case of this previously reported in the English literature to the best of our knowledge. 5 …”