Chapel F, Baume D, Bereder J M
Department of Pathology, Hôpital Font-Pré, Toulon, France.
Pathol Res Pract. 1999;195(1):53-6; discussion 57-8. doi: 10.1016/S0344-0338(99)80096-X.
The prevalence of splenic metastasis from carcinomas varies between 2% and 13% in autopsy studies. Most of them are clinically inapparent. We report herein the case of a splenic metastasis revealing breast carcinoma in a 73-year old woman. Splenectomy was performed to correct hypersplenism. Macroscopically, the cut surface of the spleen was uniform and pale. On microscopical examination, the metastatic infiltration involved both red and white pulp as single cells, cords and micro-nodules. Tumor cells were positive for cytokeratin and epithelial membrane antigen (EMA). The breast origin of this splenic metastasis was supported by the increase of CA 15-3 level, and by the appearance of axillary lymphadenopathy. In addition, the red pulp sinuses were obliterated by multiple thrombi at different stages of development and the splenic cords were collagenized. These changes could result from an unusual stromal reaction.
尸检研究表明，癌性脾转移的发生率在2%至13%之间。其中大多数在临床上并无明显表现。我们在此报告一例73岁女性因脾转移而发现乳腺癌的病例。为纠正脾功能亢进实施了脾切除术。大体上，脾脏切面均匀且苍白。显微镜检查显示，转移浸润累及红髓和白髓，呈单个细胞、条索状及微小结节状。肿瘤细胞细胞角蛋白和上皮膜抗原（EMA）呈阳性。CA 15 - 3水平升高以及腋窝淋巴结肿大支持了该脾转移灶的乳腺来源。此外，红髓血窦被处于不同发育阶段的多个血栓阻塞，脾索发生胶原化。这些改变可能源于一种异常的间质反应。
