Skip to main content
SpringerLink
Log in

Splenectomy for non-haematological metastatic malignant disease

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Harman JW, Dacorso P (1948) Spread of carcinoma to the spleen. Arch Pathol 45:179–186

    CAS  Google Scholar 

  2. Hirst AE, Bullock WK (1952) Metastatic carcinoma of the spleen. Am J Med Sci 223:414–417

    Article  PubMed  Google Scholar 

  3. Warren S, Davies AH (1934) Studies on tumor metastasis: the metastases of carcinoma to the spleen. Am J Cancer 21:517–533

    Google Scholar 

  4. Berge T (1974) Splenic metastases. Frequencies and patterns. Acta Pathol Microbiol Scand A 82:499–506

    PubMed  CAS  Google Scholar 

  5. Schon CA, Gorg C, Ramaswamy A, Barth PJ (2006) Splenic metastases in a large unselected autopsy series. Pathol Res Pract 202:351–356

    Article  PubMed  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. Lam KY, Tang V (2000) Metastatic tumors to the spleen: a 25-year clinicopathologic study. Arch Pathol Lab Med 124:526–530

    PubMed  CAS  Google Scholar 

  9. de Wilt JHW, McCarthy WH, Thompson JF (2003) Surgical treatment of splenic metastases in patients with melanoma. J Am Coll Surg 197:38–43

    Article  PubMed  Google Scholar 

  10. Lee SS, Morgenstern L, Phillips EH, Hiatt JR, Margulies DR (2000) Splenectomy for splenic metastases: a changing clinical spectrum. Am Surg 66:837–840

    PubMed  CAS  Google Scholar 

  11. 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

    Google Scholar 

  12. Falk S, Stutte HJ (1989) Splenic metastasis in an ileal carcinoid tumor. Pathol Res Pract 185:238–242

    PubMed  CAS  Google Scholar 

  13. 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

    PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    PubMed  CAS  Google Scholar 

  16. 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

    PubMed  CAS  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. Nguyen MM, Corr AS, Evans CP (2004) Testicular cancer metastatic exclusively to the brain and spleen. Urology 63:176–178

    Article  PubMed  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. 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

    Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. Colombo N, Parma G, Zanagnolo V, Insinga A (2007) Management of ovarian stromal cell tumours. J Clin Oncol 25:2944–2951

    Article  PubMed  CAS  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. Gemignani ML, Chi DS, Gurin CC, Curtin JP, Barakat RR (1999) Splenectomy in recurrent epithelial ovarian cancer. Gynecol Oncol 72:407–410

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. Thomas SM, Fitzerald JB, Pollock RE, Evans DB (1993) Isolated splenic metastases from colon carcinoma. Eur J Surg Oncol 19:485–490

    PubMed  CAS  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. Motzer RJ, Bander NH, Nanus DM (1996) Renal Cell Carcinoma. N Engl J Med 335:865–875

    Article  PubMed  CAS  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. Iype S, Akbar MA, Krishna G (2002) Isolated splenic metastasis from carcinoma of the breast. Postgrad Med J 78:173–174

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. Trindade MRM, Blaya R, Trindade EN (2009) Melanoma metastasis to the spleen: laparoscopic approach. J Min Access Surg 5:17–19

    Article  Google Scholar 

  39. 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

    PubMed  CAS  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. 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

    PubMed  CAS  Google Scholar 

  42. Koh YS, Kim JC, Cho CK (2004) Splenectomy for solitary splenic metastasis of ovarian cancer. BMC Cancer 4:96

    Article  PubMed  Google Scholar 

  43. 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

    Article  PubMed  CAS  Google Scholar 

  44. Furukawa N (2007) Solitary splenic metastasis of ovarian cancer. Arch Gynecol Obstet 275:499–502

    Article  PubMed  Google Scholar 

  45. 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

    PubMed  Google Scholar 

  46. Alloni R, Garberini A, Caputo D, Coppola R (2008) Solitary splenic metastasis of ovarian carcinoma: report of two cases. Surg Today 38:1144–1147

    Article  PubMed  Google Scholar 

  47. 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

    Article  Google Scholar 

  48. 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

    Article  Google Scholar 

  49. 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

    PubMed  CAS  Google Scholar 

  50. Place RJ (2001) Isolated colon cancer metastasis to the spleen. Am Surg 67:454–457

    PubMed  CAS  Google Scholar 

  51. 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

    Article  PubMed  CAS  Google Scholar 

  52. Okuyama T, Oya M, Ishikawa H (2001) Isolated splenic metastasis of sigmoid colon cancer: a case report. Jpn J Clin Oncol 31:341–345

    Article  PubMed  CAS  Google Scholar 

  53. Gencosmanoglu R, Aker F, Kir G, Tozun N (2006) Isolated metachronous splenic metastasis from synchronous colon cancer. World J Surg Oncol 4:42

    Article  PubMed  Google Scholar 

  54. 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

    PubMed  Google Scholar 

  55. 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

    PubMed  Google Scholar 

  56. 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

    Article  PubMed  CAS  Google Scholar 

  57. 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

    Article  PubMed  CAS  Google Scholar 

  58. 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

    Article  Google Scholar 

  59. 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

    Google Scholar 

  60. 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

    Article  PubMed  Google Scholar 

  61. 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

    PubMed  CAS  Google Scholar 

  62. 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

    PubMed  CAS  Google Scholar 

  63. 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

    Article  PubMed  Google Scholar 

  64. Schmidt BJ, Smith SL (2004) Isolated splenic metastasis from primary lung adenocarcinoma. S Med J 97:298–300

    Article  Google Scholar 

  65. 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

    Article  PubMed  Google Scholar 

  66. 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

    PubMed  Google Scholar 

  67. 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

    PubMed  CAS  Google Scholar 

  68. 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

    Article  PubMed  Google Scholar 

  69. 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

    Article  Google Scholar 

  70. 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

    Article  PubMed  Google Scholar 

  71. 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

    Article  PubMed  CAS  Google Scholar 

  72. Kimura Y, Miyazaki M, Saeki H, Ohga T, Nozoe T, Sugimachi K (2003) Solitary splenic metastasis derived from oesophageal cancer. Hepatogastroenterology 50:1336–1337

    PubMed  Google Scholar 

  73. Sanyal A, Kaman L, Sinha SK (2005) Splenic metastasis from esophageal cancer: report of a case. Surg Today 35:988–990

    Article  PubMed  Google Scholar 

  74. 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

    Article  Google Scholar 

  75. 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

    PubMed  Google Scholar 

  76. 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

    Article  PubMed  Google Scholar 

  77. 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

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Academic Department of Surgery, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Piers A. C. Gatenby & Satvinder S. Mudan

  2. Department of Histopathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Andrew C. Wotherspoon

  3. Oesophagogastric and Hepatopancreaticobiliary Surgery, Academic Department of Surgery, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Piers A. C. Gatenby

Authors
  1. Piers A. C. Gatenby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satvinder S. Mudan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew C. Wotherspoon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piers A. C. Gatenby.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-011-0746-2

Keywords

Search

Navigation