Yoshizawa Junichi, Kubo Naoki, Ishizone Satoshi, Karasawa Fumitoshi, Nakayama Ataru
Department of Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Ikeda, Ikeda-machi, Kitaazumi-gun, Nagano, Prefecture, 399-8695, Japan.
Present address: Suwa Red Cross Hospital, 5-11-50 Kogandori, Suwa-shi, Nagano, Prefecture, 392-8510, Japan.
BMC Cancer. 2017 Jun 20;17(1):436. doi: 10.1186/s12885-017-3434-y.
Solitary metastasis of a malignancy to the spleen is rare, particularly for gastric cancer. Only a few case reports have documented isolated splenic metastasis from early gastric cancer. We describe a case of splenic metastasis from early gastric cancer.
A 60-year-old man underwent a distal gastrectomy for early gastric cancer. It infiltrated the submucosa with pathological nodal involvement (pT1bN2M0, stage IIB). One year after the gastrectomy, an abdominal computed tomography scan showed a low-density lesion, 17 mm in diameter, at the upper pole of the spleen. Positron emission tomography/computed tomography showed focal accumulation of fluorine-18 fluorodeoxyglucose in the spleen without extrasplenic tumor dissemination or metastasis. We diagnosed splenic metastasis of gastric cancer, and performed a splenectomy. Histological examination confirmed moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma (solid type) that was consistent with the features of the primary gastric cancer. The splenic tumor was pathologically and immunohistochemically diagnosed as a metastasis from the gastric carcinoma. More than 18 months after the splenectomy, the patient has had no evidence of recurrent gastric cancer.
When solitary metastasis to the spleen is suspected during the postoperative follow-up of a patient with gastric cancer, a splenectomy is a potentially effective treatment.
恶性肿瘤孤立性转移至脾脏罕见，尤其是对于胃癌而言。仅有少数病例报告记录了早期胃癌的孤立性脾转移。我们描述一例早期胃癌脾转移的病例。
一名60岁男性因早期胃癌接受了远端胃切除术。肿瘤浸润至黏膜下层且伴有病理淋巴结受累（pT1bN2M0，IIB期）。胃切除术后一年，腹部计算机断层扫描显示脾脏上极有一个直径17毫米的低密度病灶。正电子发射断层扫描/计算机断层扫描显示脾脏内有氟-18氟脱氧葡萄糖局灶性聚集，无脾外肿瘤播散或转移。我们诊断为胃癌脾转移，并进行了脾切除术。组织学检查证实为中分化管状腺癌和低分化腺癌（实体型），与原发性胃癌的特征相符。脾脏肿瘤经病理和免疫组化诊断为胃癌转移。脾切除术后超过18个月，患者无胃癌复发迹象。
在胃癌患者术后随访期间，当怀疑有脾脏孤立性转移时，脾切除术是一种潜在有效的治疗方法。
