Abstract
Purpose
Multiple cases and small series of patients who have undergone splenectomy for metastatic malignant disease have been reported. This study examines the outcome of patients with metastatic malignant disease to the spleen treated by splenectomy at a tertiary oncology centre and a review of cases published in the last 10 years.
Methods
The hospital histopathology database was searched over a 25-year period up to 2004 for patients who had undergone splenectomy for non-haematological malignancy. Medical records of these patients were reviewed and clinical course was examined. The literature review was undertaken using a search of PubMed for the terms “splenectomy” and “metastasis” from 2000 to 2010.
Results
Twenty-one cases at our institution were identified. The most common primary site of malignancy was ovary (nine cases), followed by malignant melanoma (three) and pancreas (three). There were two cases of metastatic disease from colonic primary and one each from renal, breast, nasopharyngeal and unknown primary disease. There were two cases of long-term disease-free survival (both primary ovarian tumours) and four cases of patients who survived more than 4 years but had disease recurrence (ovarian and colonic primaries). The literature review provided a further 115 cases.
Conclusions
More favorable outcomes were seen in patients with metachronous disease. There was a trend to improved outcome in ovarian and colorectal primaries over malignant melanoma. It is postulated that improved outcome may be seen in patients for whom there were effective adjuvant chemotherapeutic options, low probability of other metastatic disease and less aggressive tumour biology. However, frequently the presentation is indicative of aggressive widespread disease with a poor prognosis.
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References
Harman JW, Dacorso P (1948) Spread of carcinoma to the spleen. Arch Pathol 45:179–186
Hirst AE, Bullock WK (1952) Metastatic carcinoma of the spleen. Am J Med Sci 223:414–417
Warren S, Davies AH (1934) Studies on tumor metastasis: the metastases of carcinoma to the spleen. Am J Cancer 21:517–533
Berge T (1974) Splenic metastases. Frequencies and patterns. Acta Pathol Microbiol Scand A 82:499–506
Schon CA, Gorg C, Ramaswamy A, Barth PJ (2006) Splenic metastases in a large unselected autopsy series. Pathol Res Pract 202:351–356
Ishida H, Konno K, Ishida J, Shirayama K, Naganuma H, Komatsuda T, Hamashima Y, Masamune O (1997) Isolated splenic metastases. J Ultrasound Med 16:743–749
Kraus MD, Fleming MD, Vonderheide RH (2001) The spleen as a diagnostic specimen: a review of 10 years’ experience at two tertiary care institutions. Cancer 91:2001–2009
Lam KY, Tang V (2000) Metastatic tumors to the spleen: a 25-year clinicopathologic study. Arch Pathol Lab Med 124:526–530
de Wilt JHW, McCarthy WH, Thompson JF (2003) Surgical treatment of splenic metastases in patients with melanoma. J Am Coll Surg 197:38–43
Lee SS, Morgenstern L, Phillips EH, Hiatt JR, Margulies DR (2000) Splenectomy for splenic metastases: a changing clinical spectrum. Am Surg 66:837–840
Comperat E, Bardier-Dupas A, Camparo P, Capron F, Charlotte F (2007) Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med 131:956–959
Falk S, Stutte HJ (1989) Splenic metastasis in an ileal carcinoid tumor. Pathol Res Pract 185:238–242
Ruther U, Schmidt A, Rupp W, Bader H, Nunnensiek C, Rassweiler J, Rothe B, Eisenberger F, Jipp P (1993) Spontaneous splenic rupture in a patient with multiloculated signet ring cell carcinoma of the urinary bladder. Eur Urol 23:417–418
Hanada K, Saito A, Nozawa H, Haruyama K, Hayashi N, Yamada M, Katagiri S, Katsurgawa H, Otsubo T, Takasaki K (2004) Histopathologically-diagnosed splenic metastasis in a hepatocellular carcinoma case with adrenal metastasis. Intern Med 43:484–489
Urabe N, Shiba M, Odaka E, Suzuki M, Fujisawa T, Yamaguchi Y (1990) A case of effective chemotherapy with CDDP and VDS for metastatic lesions of the lung and spleen and simultaneous resection. Gan To Kagaku Ryoho 17:2091–1095
Chouahnia K, Des Guetz G, Bouillet T, Maissiat E, Breau JL (2004) Splenic metastasis from a primary carcinoma of the periform sinus. J Chir Paris 141:107
Tatsuta M, Shiozaki K, Masutani S, Hashimoto K, Imamura H, Ikeda M, Miya A, Ishida H, Kawasaki T, Furukawa H, Satomi T, Hoshida Y (2001) Splenic and pulmonary metastases from renal cell carcinoma: report of a case. Surg Today 31:463–465
Nguyen MM, Corr AS, Evans CP (2004) Testicular cancer metastatic exclusively to the brain and spleen. Urology 63:176–178
Paolini R, Toffoli S, Poletti A, Casara D, Moschino P, Fabris F, Girolami A (1997) Splenomegaly as the first manifestation of thyroid cancer metastases. Tumori 83:779–782
Sauer J, Sobolewski K, Dommisch K (2009) Splenic metastases–not a frequent problem, but an underestimate location of metastases: epidemiology and course. J Cancer Res Clin Oncol 135:667–671
Hoskins WJ, Bundy BN, Thigpen JT, Omura GA (1992) The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 47:159–166
Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, Ball H, Berek JS (1994) The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 170:974–979
Klein B, Stein M, Kuten A, Steiner M, Barshalom D, Robinson E, Gal D (1987) Splenomegaly and solitary spleen metastasis in solid tumors. Cancer 60:100–102
Montemurro S, Maselli E, Ruggieri E, Caliandro C, Rucci A, Zito AF, Sciscio V (2008) Isolated splenic metastasis from colon cancer. Rep case Tumori 94:422–425
Wood TF, DiFronzo LA, Rose DM, Haigh PI, Stern SL, Wanek L, Essner R, Morton DL (2001) Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival. Ann Surg Oncol 8:658–662
Colombo N, Parma G, Zanagnolo V, Insinga A (2007) Management of ovarian stromal cell tumours. J Clin Oncol 25:2944–2951
Aebi S, Castiglione M, ESMO Guidelines Working Group (2009) Newly and relapsed epithelial ovarian carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20:iv21–iv23
Ayhan A, Al RA, Baykal C, Demirtas E, Ayhan A, Yuce K (2004) The influence of splenic metastases on survival FIGO stage IIIC epithelial ovarian cancer. Int J Gynecol Cancer 14:51–56
Gemignani ML, Chi DS, Gurin CC, Curtin JP, Barakat RR (1999) Splenectomy in recurrent epithelial ovarian cancer. Gynecol Oncol 72:407–410
Cascinu S, Jelic S, ESMO Guidelines Working Group (2009) Pancreatic cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20:iv37–iv40
Thomas SM, Fitzerald JB, Pollock RE, Evans DB (1993) Isolated splenic metastases from colon carcinoma. Eur J Surg Oncol 19:485–490
Aoki T, Umekita N, Tanaka S, Noda K, Warabi M, Kitamura M (2008) Prognostic value of concomitant resection of extrahepatic disease in patients with liver metastases of colorectal origin. Surgery 143:706–714
Motzer RJ, Bander NH, Nanus DM (1996) Renal Cell Carcinoma. N Engl J Med 335:865–875
Kugel V, Dekel Y, Konichezky M, Baniel J, Livne PM, Koren R (2003) Unusual splenic metastasis from renal cell carcinoma. A case report and review of the literature. Pathol Res Pract 199:739–743
Iype S, Akbar MA, Krishna G (2002) Isolated splenic metastasis from carcinoma of the breast. Postgrad Med J 78:173–174
Raval MV, Zemon H, Kumar SS, Brody FJ (2005) Laparoscopic splenectomy for metastatic squamous cell cancer of the neck. J Laparoendosc Adv Surg Tech A 15:383–386
Krapohl BD, Komurcu F, Deutinger M (2005) Spleen rupture due to metastasis of thin melanoma (Breslow thickness of 0.75 mm). Melanoma Res 15:135
Trindade MRM, Blaya R, Trindade EN (2009) Melanoma metastasis to the spleen: laparoscopic approach. J Min Access Surg 5:17–19
Mastroianni M, Di Vagno G, Melilli GA, La Pressa M, Digeslu A, Cazolla A, Fontana A, Selvaggi L (2000) Splenic involvement in ovarian cancer. Description of three cases. Minerva Ginecol 52:127–129
Yano H, Iwazawa T, Kinuta M, Nakano Y, Tono T, Matsui S, Kanoh T, Monden T (2002) Solitary splenic metastasis from ovarian cancer successfully treated by hand-assisted laparoscopic splenectomy: report of a case. Surg Today 32:750–752
Lauro S, Trasatti L, Capalbo C, Conti A, Ricci F, Mingazzini PL, Vecchione A (2002) Solitary splenic recurrence of epithelial ovarian cancer: a case report and review. Anticancer Res 22:3643–3645
Koh YS, Kim JC, Cho CK (2004) Splenectomy for solitary splenic metastasis of ovarian cancer. BMC Cancer 4:96
Otrock ZK, Seoud MA, Khalifeh MJ, Makarem JA, Shamseddine AI (2006) Laparoscopic splenectomy for isolated parenchymal splenic metastasis of ovarian cancer. Int J Gynecol Cancer 16:1933–1935
Furukawa N (2007) Solitary splenic metastasis of ovarian cancer. Arch Gynecol Obstet 275:499–502
Yoshioka R, Okabayashi T, Nishimori I, Maeda N, Sugimoto T, Kohsaki T, Onishi S, Fukaya T, Kobayashi M, Hanazaki K (2008) A long-survived case with solitary splenic metastasis from ovarian carcinoma. Surg Technol Int 17:192–194
Alloni R, Garberini A, Caputo D, Coppola R (2008) Solitary splenic metastasis of ovarian carcinoma: report of two cases. Surg Today 38:1144–1147
Ghani AA, Hashmi ZA, Chase DM, Patel SB, Jones DF (2010) Intraparenchymal metastases to the spleen from ovarian cancer: a case report. J Med Case Rep 4:30
van Ufford HMQ, Zoon PJ, van Waes PF, van Herk G, de Klerk JM (2005) Solitary splenic metastasis in a patient with a malignant melanoma diagnosed with F-18-FDG PET scanning. Clin Nucl Med 30:582–583
Kim JC, Jeong CS, Kim HC, Yu CS, Kang GH, Lee MG (2000) Isolated splenic metastasis from colorectal carcinoma: a case report. J Korean Med Sci 15:355–358
Place RJ (2001) Isolated colon cancer metastasis to the spleen. Am Surg 67:454–457
Avesani EC, Cioffi U, De Simone M, Botti F, Carrara A, Ferrero S (2001) Synchronous isolated splenic metastasis from colon carcinoma. Am J Clin Oncol 24:311–312
Okuyama T, Oya M, Ishikawa H (2001) Isolated splenic metastasis of sigmoid colon cancer: a case report. Jpn J Clin Oncol 31:341–345
Gencosmanoglu R, Aker F, Kir G, Tozun N (2006) Isolated metachronous splenic metastasis from synchronous colon cancer. World J Surg Oncol 4:42
Hiraiwa K, Morozumi K, Miyazaki H, Sotome K, Furukawa A, Nakamaru M, Tanaka Y, Iri H (2006) Isolated splenic vein thrombosis secondary to splenic metastasis: a case report. World J Gastroenterol 12:6561–6563
Pisanu A, Ravarino A, Nieddu R, Uccheddu A (2007) Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: a case report and review of the literature. World J Gastroenterol 13:5516–5520
Bigot P, Goodman C, Hamy A, Teyssedou C, Arnaud JP (2008) Isolated splenic metastasis from colorectal cancer: report of a case. J Gastrointest Surg 12:981–982
Gasent Blesa JM, de la Morena E, Laforga Canales JB, Vilaseca Martinez D, Vasquez C (2008) Clinical case report and literature review: metachronous colorectal splenic metastases. Clin Transl Oncol 10:445–447
Sileri P, D’Ugo S, Benavoli D, Stolfi VM, Palmieri G, Mele A, Gaspari AL (2009) Metachronous splenic metastasis from colonic carcinoma five years after surgery: a case report and literature review. S Med J 102:733–735
Busic Z, Cupurdija K, Kolovrat M, Cavka M, Patrlj L, Servis D, Kvesic A (2010) Isolated splenic metastasis from colon cancer—case report and literature review. Coll Antropol 35:287–290
McGregor DH, Wu Y, Weston AP, McAnaw MP, Bromfield C, Bhattatiry MM (2003) Metastatic renal cell carcinoma of spleen diagnosed by fine-needle aspiration. Am J Med Sci 326:51–54
Hadjileontis C, Amplianitis I, Valsamides C, Harisis G, Nepka H, Kafanas A (2004) Solitary splenic metastasis of endometrial carcinoma ten years after hysterectomy. Case report and review of the literature. Eur J Gynaecol Oncol 25:233–235
Gogas H, Ignatiadis T, Markopoulos C, Karageorgopoulou S, Floros D, Vaiopoulos G (2004) Solitary spleen metastasis and amyloidosis in a patient with endometrial cancer. Eur J Gynaecol Oncol 25:391–393
Piura B, Rabinovitch A, Apel-Sarid L, Shaco-Levy R (2009) Splenic metastasis from endometrial carcinoma: report of a case and review of literature. Arch Gynecol Obstet 280:1001–1006
Schmidt BJ, Smith SL (2004) Isolated splenic metastasis from primary lung adenocarcinoma. S Med J 97:298–300
Sanchez-Romero A, Oliver I, Costa D, Orduna A, Lacueva J, Perez-Vicente F, Arroyo A, Calpena R (2006) Giant splenic metastasis due to lung adenocarcinoma. Clin Transl Oncol 8:294–295
Van Hul I, Cools P, Rutsaert R (2008) Solitary splenic metastasis of an adenocarcinoma of the lung 2 years postoperatively. Acta Chir Belg 108:462–463
Opocher E, Santambrogio R, Bianchi P, De Simone M, Vellini S, Montorsi M (2000) Isolated splenic metastasis from gastric carcinoma: value of CEA and CA19-9 in early diagnosis: report of two cases. Am J Clin Oncol 23:579–580
Yamanouchi K, Ikematsu Y, Waki S, Kida H, Nishiwaki Y, Gotoh K, Ozawa T, Uchimura M (2002) Solitary splenic metastasis from gastric cancer: report of a case. Surg Today 32:1081–1084
Sunitsch S, Eberl T, Jagoditsch M, Filipot U, Tschmelitsch J, Langner C (2009) Solitary giant splenic metastasis in a patient with metachronous gastric cancers. S Med J 102:864–866
Kawasaki H, Kitayama J, Ishigama H, Hidemura A, Kaisaki S, Nagawa H (2010) Solitary splenic metastasis from early gastric cancer. Surg Today 40:60–63
Shimoyama S, Kuramoto S, Kawahara M, Yamasaki K, Endo H, Murakami T, Kaminishi M (2001) A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis. J Gastroenterol Hepatol 16:825–829
Kimura Y, Miyazaki M, Saeki H, Ohga T, Nozoe T, Sugimachi K (2003) Solitary splenic metastasis derived from oesophageal cancer. Hepatogastroenterology 50:1336–1337
Sanyal A, Kaman L, Sinha SK (2005) Splenic metastasis from esophageal cancer: report of a case. Surg Today 35:988–990
Pang LC (2004) Solitary recurrent metastasis of squamous cell carcinoma of the uterine cervix in the spleen: case report. S Med J 97:301–304
Hayashi H, Tanaka S, Shuto T, Tanaka H, Ichikawa T, Yamamoto T, Takemura S, Hirohashi K, Kubo S (2006) Splenic metastasis of hepatocellular carcinoma. Osaka City Med J 52:79–82
Iwaki K, Ohta M, Ishio T, Kai S, Iwashita Y, Shibata K, Himeno K, Seike M, Fujioka T, Kitano S (2008) Metastasis of hepatocellular carcinoma to spleen and small intestine. J Hepatobiliary Pancreat Surg 15:213–219
Comperat E, Azzouzi AR, Chartier-Kastler E, Menegaux F, Capron F, Richard F, Charlotte F (2007) Late recurrence of a prostatic adenocarcinoma as a solitary splenic metastasis. Urol Int 78:86–88
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Gatenby, P.A.C., Mudan, S.S. & Wotherspoon, A.C. Splenectomy for non-haematological metastatic malignant disease. Langenbecks Arch Surg 396, 625–638 (2011). https://doi.org/10.1007/s00423-011-0746-2
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DOI: https://doi.org/10.1007/s00423-011-0746-2