Isolated splenic metastasis from lung cancer: ringleader of continuous fever

Abstract

The spleen is an infrequent metastatic organ of solid tumours, the prevalence of which ranges between 2.3% and 7.1% in populations with cancer as determined through autopsy. The most common sources of metastasis are breast, lung, colorectal and ovarian carcinoma and melanoma. Isolated metastasis of the spleen is rarely reported with only 93 cases from all sources having been reported up to 2007. Therefore, isolated splenic metastasis from primary lung cancer is exceedingly rare with only 11 cases reported to date.Herein, we report a rare case of isolated splenic metastasis in a 49-yr-old female 3 months after lobectomy for an undifferentiated large cell carcinoma in the right lung (pT 2a N 0 M 0 ). The only symptom the patient presented with was continuous high fever, which had never been previously reported. This patient presented diagnostic challenges due to the presentation of high fever, leukoapenia after chemotherapy and the cystic splenic mass, all of which led to the initial consideration of splenic abscess. The patient's high fever resolved rapidly after splenectomy and splenic metastasis was confirmed by pathological findings.We also reviewed all 11 reported previously cases and summarised the characteristics and appropriate management of isolated splenic metastasis from lung cancer.KEYWORDS: Fever, lung cancer, splenectomy, splenic metastasis ). Although the chemotherapy was thought to be responsible for myelosuppression and a secondary infection, no other symptoms existed to indicate the site of infection. The patient was admitted and treated with granulocyte colonystimulating factors and antibiotics. However, even though strong, broad spectrum anti-infection strategies were administered and the WBC recovered the patient's high fever was not resolved. Surprisingly, the abdominal ultrasonic inspection revealed a solid, cystic mass in the spleen 8.268.1 cm in size. A further abdominal CT scan also showed a 9.568.0 cm splenic mass with complex solid and cystic components ( fig. 1b). Splenic abscess was initially considered due to the manifestation of high fever only. However, percutaneous splenic puncture guided by ultrasound showed little fluid, which was cultured with no bacteria. Due to her history of lung cancer, splenic metastasis was considered; however, a chest CT

Isolated spleen recurrence in a patient with lung adenocarcinoma: A case report

“…Therefore, abdominal CT scans should be considered for use if spleen metastasis is suspected. Several studies have reported the clinical significance of FDG-PET/CT scanning in the detection of spleen metastasis from lung cancer (13)(14)(15)(16)(17). In the present case, FDG-PET/CT was useful for confirming the presence of malignant lesions in the spleen.…”

“…The latter two types might not be apparent in abdominal CT scans, although FDG-PET/CT scanning may detect the diffuse type of spleen metastasis. In our previous study, the solitary nodular type was the most common, and in a review of recent case reports, the solitary type was confirmed as the most common type (10,(12)(13)(14)(15)(16)(17)(19)(20)(21)23,26). The differential diagnosis of a solitary nodule or nodules in the spleen includes several diseases, either benign or malignant (31).…”

“…Therefore, it was concluded at that time that spleen mass accompanying metastasis to other abdominal organs in patients with a known lung cancer should be regarded as a metastasis. We recently conducted a review of patients with lung cancer and spleen metastasis, and found 20 such patients (10)(11)(12)(13)(14)(15)17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). In these 20 patients, it was notable that all but 4 of the 20 patients had no abdominal metastasis other than spleen metastasis.…”

“…The differential diagnosis of a solitary nodule or nodules in the spleen includes several diseases, either benign or malignant (31). In differential diagnosis, FDG-PET/CT scanning can be useful to identify whether the lesion is malignant (13)(14)(15)(16)(17).…”

Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: Systematic review and analysis of reported cases

“…This manner of presentation is rare and available literatures are mostly in the form of case reports or descriptive case series containing small number of patients [12,13]. Furthermore, it is extremely difficult to conduct a prospective clinical trial to compare the outcome of chemotherapy vs. metastatectomy in these cases given the rarity of such presentation and existing strong practice preference among various clinicians.…”