Kawashima Keisuke, Kito Yusuke, Tochii Koya, Kimura Masaki, Takeda Taro, Sekino Takafumi, Ikeda Tsuneko, Takeuchi Tamotsu
Department of Pathology, Matsunami General Hospital, Gifu, Japan.
Department of Surgery, Matsunami General Hospital, Gifu, Japan.
SAGE Open Med Case Rep. 2021 May 24;9:2050313X211016992. doi: 10.1177/2050313X211016992. eCollection 2021.
The spleen has no epithelial element; thus, primary carcinoma of the spleen is quite rare. We present the case of a patient with serous carcinoma of the spleen. A 76-year-old woman with no significant medical history presented with a huge lesion in the spleen. Except this lesion, clinical examination, including imaging examination, revealed no remarkable findings. She underwent excision of the spleen for treatment and diagnosis. Postoperative pathological examination revealed neoplastic cells with pleomorphic and hyperchromatic nuclei, prominent nucleoli, and frequent mitotic activity. The neoplastic cells exhibited a papillary pattern with psammoma bodies. Immunohistochemistry showed positivity for cytokeratin 7, PAX-8, WT-1, p16, p53, and Ber-EP4 and negativity for cytokeratin 20, thyroid transcription factor-1, carcinoembryonic antigen, CD10, estrogen receptor, calretinin, D2-40, intelectin-1, and sialylated HEG1. We inferred that this tumor was a primary splenic serous carcinoma. Serous tubal intraepithelial carcinoma is the plausible origin of most pelvic serous carcinomas. However, the origin of serous carcinoma of the spleen remains unknown. We speculated that endosalpingiosis might be the origin of the tumor.
脾脏没有上皮成分；因此，原发性脾癌相当罕见。我们报告一例脾脏浆液性癌患者的病例。一名76岁无重大病史的女性因脾脏巨大病变就诊。除该病变外，包括影像学检查在内的临床检查未发现明显异常。她接受了脾脏切除术以进行治疗和诊断。术后病理检查显示肿瘤细胞具有多形性和核深染、核仁突出以及频繁的有丝分裂活性。肿瘤细胞呈乳头样结构并伴有砂粒体。免疫组化显示细胞角蛋白7、PAX-8、WT-1、p16、p53和Ber-EP4呈阳性，而细胞角蛋白20、甲状腺转录因子-1、癌胚抗原、CD10、雌激素受体、钙视网膜蛋白、D2-40、凝集素-1和唾液酸化HEG1呈阴性。我们推断该肿瘤为原发性脾脏浆液性癌。浆液性输卵管上皮内癌是大多数盆腔浆液性癌可能的起源。然而，脾脏浆液性癌的起源仍然未知。我们推测输卵管内膜异位可能是该肿瘤的起源。
