Pavlović Mirjana, Separović Robert, Vukelić-Marković Mirjana, Patrlj Leonardo, Kolovrat Marijan, Kopljar Mario, Babić Nenad, Kosuta Dragutin, Babić Zarko
University of Zagreb, School of Medicine, 'Sestre Milosrdnice" University Hospital Center, Department for Internistic Oncology and Chemotherapy, Zagreb, Croatia.
Coll Antropol. 2011 Dec;35(4):1307-10.
Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made.
结直肠癌孤立性脾转移是一种罕见的情况。我们报告一例74岁男性，有II型糖尿病和阵发性心房颤动病史，于2004年8月因盲肠腺癌接受了右半结肠切除术。2007年6月，该患者被诊断为重度主动脉瓣狭窄以及左冠状动脉第一钝缘支长节段狭窄。他被建议进行主动脉瓣置换术并冠状动脉搭桥术，但他拒绝了手术。2007年10月，由于癌胚抗原（CEA）血清水平升高，患者接受α 18氟脱氧葡萄糖（18FDG）-正电子发射断层扫描（PET），结果显示脾脏有一个5厘米大的孤立性高代谢病灶。由于手术风险，外科医生拒绝了脾切除术。在癌胚抗原水平开始升高且多层螺旋CT（MSCT）显示脾转移灶大小进展之前，患者总共接受了8个周期的卡培他滨化疗。由一组专家对患者病情进行重新评估后，于2008年9月进行了脾切除术。2009年5月术后随访期间，MSCT扫描显示腹腔区域淋巴结肿大以及肝脏有可疑转移病灶，患者入院接受进一步化疗。由于文献报道的病例数量较少，这种情况尚无标准化治疗方案。脾切除术后化疗似乎是一种最佳治疗方法，但仍无法得出最终结论。
