Mudan Satwinder, Kumar Jayant, Mafalda Neves C, Kusano Tomokazu, Reccia Isabella, Zanallato Artur, Dalgleish Angus, Habib Nagy
Department of Surgery, The Royal Marsden NHS Trust, Sutton Department of Surgery & Cancer, Imperial College London Department of Oncology, St George's Hospital, London, UK.
Medicine (Baltimore). 2017 Dec;96(49):e9106. doi: 10.1097/MD.0000000000009106.
An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors.
We report a case of a 60-year-old man who presented with multiple lung metastases and a solitary splenic metastasis with advanced stage melanoma following excision of primary from his trunk 2.3 years back.
Considering the diagnosis of advanced stage melanoma with multiple lung metastases and a solitary splenic metastasis, and its ongoing progressive nature. This case was discussed in the tumour board meeting.
A decision was made to commence treatment with immunotherapy in the form of PD-1 inhibitor (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer tomography (CT) scan of the abdomen and chest showed a significant reduction in the lung and chest wall lesions, but the splenic lesion remained unchanged. Given the lack of response to treatment in the splenic metastasis and the significant decrease in lung metastases, the multidisciplinary team decided that a partial splenectomy combined with continued immunotherapy treatment would be appropriate as the success of immunotherapy was imminent within the splenic preservation.
The postoperative recovery was smooth and the patient was discharged from hospital on the sixth postoperative day with normal platelets and white blood cells. The histopathological analysis of the resected specimen showed a metastatic melanoma with negative margins.At 10-month follow-up after the splenic resection the patient had not experienced further tumour recurrences.
Spleen-preserving resection for an isolated, solitary splenic metastasis of melanoma is a feasible approach as it not only preserves the ongoing efficacy of checkpoint inhibitors by preserving the physiological T cell milieu, but the immunomodulation properties of RF can produce potentially additional therapeutic benefit.
孤立性脾转移是晚期黑色素瘤中一种罕见的现象。我们报告了基于射频（RF）的保留脾脏脾切除术在一名晚期黑色素瘤孤立性脾转移患者中的作用，该患者接受了检查点抑制剂治疗。
我们报告了一例60岁男性患者，2.3年前其躯干原发性黑色素瘤切除术后出现晚期黑色素瘤伴多发肺转移和孤立性脾转移。
考虑为晚期黑色素瘤伴多发肺转移和孤立性脾转移，且病情呈进行性发展。该病例在肿瘤多学科讨论会上进行了讨论。
决定开始使用PD-1抑制剂派姆单抗进行免疫治疗。腹部和胸部的随访重新分期计算机断层扫描（CT）显示肺和胸壁病变明显减少，但脾脏病变无变化。鉴于脾转移对治疗无反应且肺转移明显减少，多学科团队决定部分脾切除术联合持续免疫治疗是合适的，因为在保留脾脏的情况下免疫治疗即将取得成功。
术后恢复顺利，患者术后第6天出院，血小板和白细胞正常。切除标本的组织病理学分析显示为转移性黑色素瘤，切缘阴性。脾切除术后10个月随访，患者未出现进一步肿瘤复发。
对于黑色素瘤孤立性脾转移，保留脾脏的切除术是一种可行的方法，因为它不仅通过保留生理性T细胞环境来维持检查点抑制剂的疗效，而且RF的免疫调节特性可能产生额外的治疗益处。
