A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer
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(2020) 18:250
CASE REPORT
Open Access
A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer Ayato Obana1,2* , Nobuo Komatsu1, Kazuma Aiba1, Shinya Nakanishi1, Masakazu Abe1, Toshiyuki Yamaguchi1, Masahiro Hayashi1, Hayato Obi1, Masamichi Koyama1 and Shinichi Hashimoto1
Abstract Background: Very rarely does a splenic solitary metastasis arise from a gastric carcinoma because splenic metastasis is usually seen in association with widespread visceral metastasis. Splenectomy is considered to be a curative treatment; however, long-term prognosis after splenectomy has scarcely been reported. We report a case of a metachronous and solitary metastasis to the spleen from gastric cancer in which the patient achieved 5-year recurrence-free survival after splenectomy. Case presentation: An 84-year-old man underwent an open total gastrectomy involving D1+ lymph nodes dissection for gastric cancer located in the cardia (pT3N1M0, pStage IIB). Eighteen months later, a 2-cm solitary hypodense lesion was detected in the spleen by computed tomography (CT). Twenty-three months later, the serum carcinoembryonic antigen (CEA) value elevated to 19.9 ng/ml, and abdominal CT revealed an increase in tumor size to 5 cm. Positron-emission tomography (PET)-CT revealed intense 18F-2-deoxy-2-fluoro-glucose (FDG) uptake in the spleen without the involvement of other organs and lymph nodes. We diagnosed him with solitary splenic metastasis from gastric cancer and performed a splenectomy 26 months after the first surgery. Histological examination revealed that the splenic tumor was a moderately differentiated adenocarcinoma, which was very similar to the primary gastric tumor; the lesion was diagnosed as a metastatic tumor from the previous gastric carcinoma. The patient remains healthy to date without recurrence, 5 years after the splenectomy. Conclusion: We experienced a case of a solitary splenic metastasis from gastric cancer in which 5-year recurrencefree survival was achieved after splenectomy. To determine the surgical indication in patients with splenic metastasis, it is important to differentiate between a solitary lesion or multiple metastasis. Especially, occult metastasis should be excluded by means of several months of follow-up with imaging tests and systemic FDG-PET surveys before splenectomy. Keywords: Splenic metastasis, Gastric cancer, Splenectomy
* Correspondence: [email protected]; [email protected] 1 Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan 2 Department of General Surgery, Kashiwa Kousei General Hospital, 617, Shikoda, Kashiwa, Chiba 277-8551, Japan © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The image
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