Asada Shimpei, Mori Shusuke, Takemoto Akira, Tamura Kazuhiro, Ito Go, Otomo Yasuhiro
Trauma and Acute Critical Care Center Tokyo Medical and Dental University Tokyo Japan.
Department of Pathology Tokyo Medical and Dental University Tokyo Japan.
Acute Med Surg. 2023 Aug 1;10(1):e879. doi: 10.1002/ams2.879. eCollection 2023 Jan-Dec.
Splenic rupture because of metastasis from a distant organ is extremely rare.
An 80-year-old man presented with left flank pain. A computed tomography (CT) demonstrated a poorly enhanced enlarged spleen with bulky thrombus in the splenic vein without extravasations. A CT on the following day showed increased intraperitoneal hemorrhage; therefore, an emergency laparotomy was performed. The spleen was enlarged and ruptured with lacerations on its surface. Macroscopic examination showed congestion with a thrombus in the splenic vein around the hilum. Pathology revealed signet-ring cell carcinoma. On the third postoperative day, a massive cerebral infarction in the left middle cerebral artery was revealed. Endoscopic examination demonstrated normal gastric mucosa except for some erosions, for which biopsies were performed, and two of five specimens encompassed signet-ring cell carcinoma in the lamina propria.
Occult cancer could result in a drastic manifestation of its metastasis accompanying systemic thrombotic events.
远处器官转移导致的脾破裂极为罕见。
一名80岁男性因左侧胁腹疼痛就诊。计算机断层扫描（CT）显示脾脏增大，强化不佳，脾静脉内有大量血栓形成，无外渗。次日的CT显示腹腔内出血增加；因此，进行了急诊剖腹手术。脾脏肿大且破裂，表面有裂伤。肉眼检查显示脾门周围脾静脉充血并伴有血栓形成。病理检查显示印戒细胞癌。术后第三天，发现左侧大脑中动脉发生大面积脑梗死。内镜检查显示胃黏膜除有一些糜烂外基本正常，遂取组织进行活检，5个标本中有2个在固有层内发现印戒细胞癌。
隐匿性癌症可导致其转移的剧烈表现并伴有全身血栓形成事件。
