Isolated splenic metastasis from carcinoma of the breast

Abstract

A case of isolated splenic metastasis from carcinoma of the breast in a 54 year old woman, two years after treatment for breast carcinoma, is presented. There was no involvement of other organs like liver, bone, lungs, etc. The patient underwent splenectomy and recovered without any complications. This case is being reported because of the rarity of the lesion. Breast carcinoma with visceral metastasis to liver, bones, lungs, etc is common. Secondary metastasis in spleen, on the other hand, is a rare entity. Though it may occur along with other visceral metastasis, isolated involvement of spleen has not yet been reported. CASE REPORTA 54 year old woman presented with left hypochondrial pain and mild fever of one month's duration. She was known to have asthma and hypertension, and she had been operated on for carcinoma of the breast (tumour, node, and metastasis staging: T 2 N 1 M 0 ) by modified radical mastectomy two years earlier. The histopathological examination showed infiltrating duct carcinoma with three metastatic lymph nodes. Other possible sites of spread revealed no metastasis. There was no family history of breast cancer. The patient received chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil; six cycles) and was on tamoxifen. Over the previous two years she had not had any significant illness.On physical examination, the patient was pale but moderately nourished. Abdominal examination revealed a mass 5 cm below the left costal margin, moving with respiration, directed towards right iliac fossa (splenomegaly). The liver was not palpable. There was no other palpable mass or ascites. Vaginal and rectal examinations were normal. The mastectomy bed, contralateral breast, and both axilla were normal. Haematological analysis showed anaemia and leucocytosis. Biochemical parameters including liver function tests and renal function tests were within normal limits. An ultrasonogram of the abdomen showed splenomegaly with a large cystic lesion in the spleen. Computed tomography of the abdomen and pelvis revealed an enlarged spleen containing a well circumscribed solitary hypodense area. The liver, retroperitoneum, and pelvis were normal. Computed tomography of the chest was normal. A splenic abscess or metastatic lesion to the spleen were considered. As there were no other lesions, the patient was prepared for laparotomy and splenectomy.Peroperatively the spleen was enlarged with an irregular surface and numerous adhesions. Few lymph nodes were present in the splenic hilum. The liver, bowels, and other viscera were normal; there was no ascites. Splenectomy was done and the postoperative period was uneventful. The patient was followed up for six months, with ultrasound scan of the abdomen, and there was no persistence or recurrent disease.The spleen was 12 × 11 × 8 cm, weighing 500 g, with an irregular surface. Cut section showed fleshy growth with extensive necrosis, 10 cm in diameter, with a rim of splenic tissue all around. Microscopic examination showed sheets and nests of cells having eosinoph...

Splenectomy for non-haematological metastatic malignant disease

“…Isolated breast cancer metastasis to the spleen has been described, but with no information on long-term outcome [35] and the young patient in our series had aggressive disease and a very poor outcome.…”

Spleen Metastasis from Thyroid Carcinoma

“…Other pathologies, such as infectious diseases, systemic disorders and metastases, are infrequent. 8 Kraus et al, 9 in a recent review of histologic diagnoses of 1,280 sequential splenectomies, found only 17 cases (1.3%) of metastasis from sarcoma or carcinoma. Metastases from nonlymphoid tumors are very rare and consist mainly of malignant melanoma, and breast and lung cancer.…”

“…Metastases from nonlymphoid tumors are very rare and consist mainly of malignant melanoma, and breast and lung cancer. 2,8 Lam and Tang, 10 in a recent review of 92 cases of metastasic carcinoma observed in the spleen, found that 19 were from lung tumors, 15 from stomach, 11 from pancreas, 9 from liver and 8 from colon but none from the thyroid gland. Only 1 case of spleen metastasis from the thyroid gland has been reported before, 11 without cytologic study.…”

“…7 Some authors have reported the importance of this technique as a tool for the evaluation of splenic lesions in oncology patients and have stressed that it has no false positive diagnoses; only 1 false negative has been found, and it was attributed to sampling error. 11 Lishner et al 16 17 However, Kraus et al 8 recommended that FNAC not be used as an initial diagnostic tool due to a perceived risk of hemorrhagic complications. FNAC is useful for primary neoplasms, lymphoid processes and infectious diseases for both diagnosis or follow-up.…”

Rare case of isolated splenic metastasis from the breast

“…Published cases of isolated splenic metastasis worldwide is less than 25 7 . Only one case of isolated splenic metastasis from carcinoma of the breast has been reported 8 …”