Isolated splenic metastases from gastric carcinoma:A case report and literature review

Isolated metastases to the spleen from gastric carcinoma is very rare.Only a few cases have been reported in the literature.We herein present a case of isolated splenic metastases in a 62-year-old man,occurring 12 mo after total gastrectomy for gastric carcinoma.The patient underwent a laparoscopic exploration,during which two lesions were found at the upper pole of the spleen,without involvement of other organs.A laparoscopic splenectomy was performed.Histological examination confirmed that the splenic tumor was a poorly differentiated adenocarcinoma similar to the primary gastric lesion.The postoperative course was uneventful and the patient has been well for 9 mo,with no tumor recurrence.The clinical data of 18 cases of isolated splenic metastases from gastric carcinoma treated by splenectomy were summarized after a literature review.To our knowledge,this is the first reported case of isolated splenic metastases undergoing laparoscopic splenectomy.     

Primary signet-ring cell carcinoma of the colon at early stage： A case report and a review of the literature

A 67-year-old man, who had undergone surgery to resect multiple gastric cancers 4 years ago, visited our hospital for surveillance colonoscopy. Colonoscopy revealed a discolored, 7-mm in diameter, flat-elevated lesion with central depression in the transverse colon near the splenic flexure. Although the findings of endoscopy and barium enema were suggestive of submucosal invasion, the patient chose to undergo endoscopic mucosal resection. Pathological examination of the resected specimen revealed signet-ring cell carcinoma and a positive surgical margin. A second operation was performed, and no residual tumor or metastasis to lymph nodes was found in the resected specimens. Primary colorectal cancers composed of signet-ring cell carcinoma detected and treated at an early stage are extremely rare. We present a case and review the literature.     

Littoral-cell angioma of the spleen： A case report

Littoral-cell angioma (LCA) is a primary splenic vascular tumor that arises from the normal littoral cells lining the sinus channels of the splenic red pulp. We report a case of LCA of the spleen, which has been infrequently communicated in the literature. A 76-year-old man with a 2-wk history of weight loss, abdominal pain and changes in bowel habits was admitted to our hospital. Imaging studies (CT and MRI) showed multiple lesions in the spleen. Splenectomy was performed. Lining cells were positive for CD31/CD68 markers. Our case was associated with a serrated colonic adenoma. LCA is a benign vascular tumor of the spleen that needs to be included in the differential diagnosis of multiple splenic nodules.     

Splenic hemangiopericytoma and serosal cavernous hemangiomatosis of the adjacent colon

A healthy 31-years-old man presented with a three-year history of abdominal discomfort. Radiological examinations revealed multifocal tumoral lesions in the spleen. The patient underwent splenectomy for differential diagnosis and treatment. During the operation, in addition to the splenic masses, there were also multiple milimetric purpuric-like lesions on the colonic serosal surfaces adjacent to the splenic hilus. One of them was excised. Histologic examination showed hemangiopericytoma of the spleen and cavernous hemangioma of the adjacent colon. This is the first report showing the close association of these two distinct lesions with vascular origin in the literature. Despite not having any apparent evidence, there may be a sequential relationship between the hemangiopericytoma of the spleen and cavernous hemangiomas.     

Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers

We report a case of metachronous multiple primary malignancies involving both rectum and liver with colonic metastasis from hepatocellular carcinoma(HCC) through hematogenous pathway.A 72-year-old woman was admitted to the emergency department with right upper abdominal pain for 4 h.Considering her surgical history of Mile’s procedure plus liver resection for rectal cancer with liver metastasis three years ago and the finding of urgent computed tomography scan on admission,the preoperative diagnosis was spontaneous rupture of rectal liver metastasis located in caudate lobe and colonic metastasis from rectal cancer. The patient underwent an emergency isolated caudate lobectomy at a hemorrhagic shock status.Pathology reported a primary HCC in the caudate lobe and colonic metastasis of HCC with tumor embolus in the surrounding vessels of the intestine.No regional lymph node involvement was found.It is hypothesized that HCC may disseminate hematogenously to the ascending colon,thus making it a rare case.     

Solitary colonic neurofibroma in a patient with transient segmental colitis： Case report

Neurofibromas of the large bowel are very rare and usually are part of the colonic involvement in neurofibromatosis type 1 (Nfl, von Recklinghausen's disease). Solitary neurofibromas of the colon are extremely rare. We describe a case of an isolated neurofibroma that was found in the large bowel of a patient who suffered from segmental colitis and presented with bloody diarrhea. A review of the literature is also included, concerning the disclosure of isolated neurofibromas in the gut and other body parts and the type of gastrointestinal involvement in von Recklinghausen's disease.     

Abscesses of the spleen： Report of three cases

Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The latter are more common in the presence of a different primary site of infection, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Moreover, immunosuppression is a major risk factor. Clinical examination usually reveals a combination of fever, left-upper-quadrant abdominal pain and vomiting. Laboratory findings are not constant. Imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. Treatment includes conservative measures, and surgical intervention. In children and in cases of solitary abscesses with a thick wall, percutaneous catheter drainage may be attempted. Otherwise, splenectomy is the preferred approach in most centers. Here, we present three cases of splenic abscess. In all three, splenectomy was performed, followed by rapid clinical improvement. These cases emphasize that current understanding of spleen abscess etiology is still limited, and a study for additional risk factors may be necessary.     

Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass:A case report

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.     

A rare case： Spontaneous cutaneous fistula of infected splenic hydatid cyst

Hydatid disease is caused by the larval stage of the genus Echinococcus. Live hydatid cysts can rupture into physiologic channels,free body cavities or adjacent organs. Although hydatid disease can develop anywhere in the human body, the liver is the most frequently involved organ, followed by the lungs. Cysts of the spleen are unusual. There are only five case reports of spontaneous cutaneous fistulization of liver hydatid cysts in the literature. But there isn't any report about cutaneous fistula caused by splenic hydatid cyst. We report a first case of spontaneous cutaneous fistula of infected splenic hydatid cyst. A 43-year-old man was admitted to our Emergency Service with abdominal pain and fluid drainage from the abdominal wall. He has been suffering from a reddish swelling on the abdominal wall skin for four months. After a white membrane had been protruded out from his abdominal wall, he was admitted to our Emergency Service. On physical examination, a white membrane was seen to protrude out from the 2cm×1cm skin defect on the left superolateral site of the umblicus. Large, complex, cystic and solid mass of 9.5 cm-diameter was located in the spleen on ultrasonographic examination. At operation, partial cystectomy and drainage was performed. After the operation, he was given a dosage of 10 mg/kg per day of albendazole, divided into three doses. He was discharged on the postoperative 10th d. It should be kept in mind that splenic hydatid cysts can cause such a rare complication.     

Imaging findings of splenic hamartoma

AIM:To assess CT and MR manifestations and their diagnosticvalue in splenic hamartoma with review of literatures.METHODS:We described a woman who was accidentallyfound to have a splenic tumor by ultrasound of the abdomen.CT and MR findings of this splenic hamartoma were provedby pathology retrospectively.RESULTS:The CT and MR findings in this case included aball-like mass with homogeneous mild-hypodensity lesionson non-enhanced CT scans or isointensity on T_1-weightedimages and mild hypointensity on T_2-weighted images,progressive homogeneous enhancement on multiple-phasespiral CT and MR enhanced scans,and isodense enhancementon delayed post-contrast CT scans and obvious hyperintensityrelative to the spleen on delayed MR images.CONCLUSION:Splenic hamartoma has some specificradiological features.However,the diagnosis of this diseasemust be based on clinical features and confirmed by pathology.     

Isolated splenic metastasis from colorectal mucinous carcinoma

Metastatic tumors of the spleen are rare and occur in the presence of disseminated visceral metastasis. Isolated splenic metastases from colorectal carcinoma are rare and only 19 cases have been reported in English literature. We report a case of isolated splenic metastasis in a 52-year-old man, occurring 9 years after the primary colorectal mucinous carcinoma was treated by anterior resection. The patient underwent splenectomy along with adjuvant chemotherapy and is alive and asymptomatic at 22 months follow-up.     

Isolated splenic metastasis from colorectal carcinoma

In general, surgical resection for metastatic colorectal adenocarcinoma rarely benefits more than a small percentage of patients long term. In the case of isolated splenic metastasis without evidence of other metastatic disease, splenectomy may increase survival times in patients with previously resected colorectal adenocarcinoma. Currently there are only five case reports involving isolated splenic metastases in the English-language literature. This article presents a sixth case and a review of the previous five cases in the literature, with a discussion on the possible diagnostic and therapeutic approaches to these rare but important cases and the apparently significant survival advantage of early diagnosis and treatment.The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the United States Government.     

Pedunculated hepatocellular carcinoma and splenic metastasis

Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes,kidney, bone marrow and adrenals. Metastasis to spleen is mostly via hematogenous metastasis, direct metastasis to spleen was very rare. We report a case of P-HCC presenting as a left upper abdominal lesions which involved the spleen that was actually a P-HCC with splenic metastasis. This case is unique as P-HCC directly involved the spleen which is not via hematogenous metastasis.     

Isolated splenic vein thrombosis secondary to splenic metastasis： A case report

INTRODUCTIONIsolated splenic vein thrombosis is a rare clinical syndrome that may lead to left-sided portal hypertension.Metastasis to the spleen from solid tumors is also considered rare.When identified it usually occurs in the setting of widely dissemin…     

Volvulus of the splenic flexure: Report of a case and review of the literature

This is the first case report of gangrenous colon from volvulus of the splenic flexure. It is also the first reported treatment of splenic flexure volvulus by exteriorization of the splenic flexure as a loop colostomy. Splenic flexure volvulus has been a rare cause of mechanical obstruction, producing 1 per cent of colonic volvuluses. Fourteen detailed case reports of splenic flexure volvulus were reviewed. Patients averaged 53.2 years old. Eight of 14 were women. Previous abdominal surgery, anomalies of fixation, and constipation played important roles in the pathogenesis. Diagnosis was made before surgery in two-thirds of the patients. Treatment varied. One patient died without treatment. In two, the volvulus reduced spontaneously. Eleven required emergency surgery. Three underwent operative detorsion, one exteriorization of the splenic flexure as a loop colostomy (the present report), and six partial colectomy. All treated patients survived without recurrence of volvulus. Thus, there was only one death in 14 cases, a seven per cent mortality rate. This low mortality rate was attributed to the rarity of gangrenous colon from splenic flexure volvulus.     

Isolated splenic metastasis from colon cancer: Case report

Isolated splenic metastases from colorectal cancer are very rare clinical entities and when they are present, they usually manifest widely disseminated disease. In this paper we report a case of metachronous solitary isolated splenic metastasis from colon cancer in a 64-year-old woman who was successfully treated by laparoscopic splenectomy. We discuss the pathological and clinical aspects of this condition. We furthermore comment on the diagnostic and therapeutic options of this rare entity through our observation of the case and consideration of the 31 case reports published in the literature.     

结直肠癌脾转移3例

目的:探讨结直肠癌脾转移的临床特征及诊治.方法:回顾分析河北医科大学附属唐山工人医院2003-2008年3例结直肠癌脾转移的临床特征、诊断、治疗及预后.结果:3例结直肠癌脾转移患者,1例结肠癌术后行PET/CT检查确诊,其余2例均诊断为脾脓肿,2例行脾切除术,1例行剖腹探查术确诊,术后2 wk死亡1例,其余2例已存活2...     

Intussusception up to splenic flexure by cecal carcinoma in an adult: report of a case

A 73-year-old woman was admitted because of constipation and appetite loss. She was diagnosed as having intussusception caused by a colonic tumor, based on the results of physical examination and imaging such as ultrasonography, computed tomography and barium enema. Operation revealed that right colon from the cecum up to the hepatic flexure of the ascending colon was not fixed to the retroperitoneum, and a circular cecal carcinoma was invaginated to the splenic flexure of the transverse colon. We experienced a rare case of ileocolic intussusception up to the splenic flexure by a cecal carcinoma with mesenterium ileo-colicum commune in an adult.     

Control of splenic bleeding during splenic flexure mobilisation by devascularisation of the inferior pole of the spleen

Injury to the spleen is a recognised complication of colorectal resections involving mobilisation of the splenic flexure. Bleeding from the spleen is difficult to control and not infrequently requires splenectomy with its attendant lifelong potential haematological and immunological complications. Furthermore, conversion from a laparoscopic to an open procedure may be required as splenic haemorrhage is more difficult to control laparoscopically. We describe a technique for control of bleeding from the inferior pole of the spleen, used during laparoscopic splenectomy, which may be applied to either open or laparoscopic surgery to achieve haemostasis thereby obviating splenectomy and in laparoscopic cases, conversion to open.