Isolated splenic metastasis from colorectal cancer

Abstract

Splenic metastases are unusual, arising in less than 1% of all metastases. Isolated solitary splenic metastasis from colorectal carcinoma is considered exceptional. This rarity has been explained by several hypotheses relating to the anatomical, histological, and immunological features of the spleen. We review the reported cases of isolated solitary splenic metastasis from colorectal carcinoma and discuss the diagnostic and therapeutic options for this entity. We searched the English-language medical literature, using the Medline and Pubmed databases from January 1966 through July 2010, for articles reporting isolated splenic metastasis from colorectal carcinoma. Only 26 cases have been reported; four cases had synchronous splenic metastasis. Fifteen patients had regional lymph node involvement on diagnosis of primary carcinoma. The primary tumor was located in the left colon or in the rectum in 18 cases. Carcinoembryonic antigen (CEA) level was elevated in 73% of cases. All patients underwent curative splenectomy; only one patient had laparoscopic resection of the spleen. Mean reported survival interval was 19.5 months; only three patients were deceased at last follow-up. Solitary splenic metastasis from colorectal carcinoma is very rare; clinicians are advised to pay close attention when routinely evaluating patients with serial CEA levels and abdominal scans. Splenectomy seems to be the preferred treatment modality with improvement of long-term survival. However, definitive conclusions cannot be drawn from the small number of case reports available.

An unusual site of metastasis: splenic metastastasis from a colon cancer

“…Isoled spleen metastasis from colorectal cancers are very rare. Since the first description by Dunder et al ., few cases have been reported [2, 8–10]. These tumors are often metachronous, found during follow-up, rarely they can be encountered synchronously with the primary tumor [2, 8].…”

“…Since the first description by Dunder et al ., few cases have been reported [2, 8–10]. These tumors are often metachronous, found during follow-up, rarely they can be encountered synchronously with the primary tumor [2, 8]. In most reported cases, the left colon is the main location of the primary tumor, especially the splenic flexture, the sigmoid or the rectum, suggesting that tumor cells invade the spleen through the mesenteric vein [2, 8].…”

“…These tumors are often metachronous, found during follow-up, rarely they can be encountered synchronously with the primary tumor [2, 8]. In most reported cases, the left colon is the main location of the primary tumor, especially the splenic flexture, the sigmoid or the rectum, suggesting that tumor cells invade the spleen through the mesenteric vein [2, 8]. Primary tumors diagnosed at advanced stage, often stage III or IV, have tendency to metastasise to spleen [2, 8].…”

“…The main primary sites of these tumors are breast, lung, skin, ovary or colon/rectum [2, 3]. Metastasis from colon are very uncommon, and the left colon is usually the source of these tumors [1–3].…”

“…Despite its rich vasculature, the spleen is very rarely involved by metastasis. The explanation to this uncommon property is unclear, but the particular anatomical and immunological features of the spleen may be the reason of the rarity of splenic secondary tumors [2, 4]. …”