Yoshioka Maika, Shimoda Masafumi, Abe Kaori, Masunaga Nanae, Tsukabe Masami, Yoshinami Tetsuhiro, Sota Yoshiaki, Miyake Tomohiro, Tanei Tomonori, Shimazu Kenzo
Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Osaka, 2-2-E10 Yamadaoka, Suita, Osaka 565-0871, Japan.
Department of Breast Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka 593-8304, Japan.
J Surg Case Rep. 2025 Sep 20;2025(9):rjaf751. doi: 10.1093/jscr/rjaf751. eCollection 2025 Sep.
Splenic metastasis is uncommon, and truly isolated splenic metastasis (ISM) from breast cancer is a clinical rarity. Contemporary autopsy series reports splenic involvement in <1% of breast cancer-related deaths, and fewer than 15 well-documented ISM cases have been published. We report a 71-year-old woman presenting with a right-breast mass, regional lymphadenopathy, and a solitary splenic lesion detected on staging computed tomography (CT) and positron emission tomography-CT. Biopsy confirmed hormone receptor-negative, HER2-positive invasive ductal carcinoma. Six cycles of docetaxel, trastuzumab, and pertuzumab led to a 59% reduction in the primary tumour and complete radiological resolution of the splenic lesion. The patient remains progression-free 22 months after initiating therapy, maintained on trastuzumab and pertuzumab. Although extremely rare, ISM can present as the initial manifestation of metastatic breast cancer. Awareness of this possibility may facilitate early systemic therapy and obviate the need for diagnostic splenectomy.
脾脏转移并不常见，真正孤立的乳腺癌脾脏转移（ISM）在临床上实属罕见。当代尸检系列报告显示，在与乳腺癌相关的死亡病例中，脾脏受累的比例不到1%，并且已发表的记录良好的ISM病例少于15例。我们报告了一名71岁女性，其在分期计算机断层扫描（CT）和正电子发射断层扫描-CT检查中发现右乳肿块、区域淋巴结肿大及一个孤立的脾脏病变。活检证实为激素受体阴性、人表皮生长因子受体2（HER2）阳性的浸润性导管癌。六个周期的多西他赛、曲妥珠单抗和帕妥珠单抗治疗使原发肿瘤缩小了59%，脾脏病变在影像学上完全消退。患者在开始治疗22个月后仍无进展，继续接受曲妥珠单抗和帕妥珠单抗治疗。尽管ISM极为罕见，但它可能作为转移性乳腺癌的初始表现出现。认识到这种可能性可能有助于早期进行全身治疗，并避免进行诊断性脾切除术。
