Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis
Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature. Aim: To report two colorectal cancer cases with atypical metastasis.
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
2010
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| Zitieren: | Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis / M. Dogan, G. Ozal, C. Ekinci, G. Utkan, Y. Urun, B. Yalcin, F. Icli // Experimental Oncology. — 2010. — Т. 32, № 4. — С. 277–279. — Біліогр.: 6 назв. — англ. |
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irk-123456789-323102013-02-13T03:31:04Z Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis Dogan, M. Ozal, G. Ekinci, C. Utkan, G. Urun, Y. Yalcin, B. Icli, F. Case report Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature. Aim: To report two colorectal cancer cases with atypical metastasis. 2010 Article Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis / M. Dogan, G. Ozal, C. Ekinci, G. Utkan, Y. Urun, B. Yalcin, F. Icli // Experimental Oncology. — 2010. — Т. 32, № 4. — С. 277–279. — Біліогр.: 6 назв. — англ. 1812-9269 http://dspace.nbuv.gov.ua/handle/123456789/32310 en Experimental Oncology Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Case report Case report |
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Case report Case report Dogan, M. Ozal, G. Ekinci, C. Utkan, G. Urun, Y. Yalcin, B. Icli, F. Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis Experimental Oncology |
| description |
Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature. Aim: To report two colorectal cancer cases with atypical metastasis. |
| format |
Article |
| author |
Dogan, M. Ozal, G. Ekinci, C. Utkan, G. Urun, Y. Yalcin, B. Icli, F. |
| author_facet |
Dogan, M. Ozal, G. Ekinci, C. Utkan, G. Urun, Y. Yalcin, B. Icli, F. |
| author_sort |
Dogan, M. |
| title |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
| title_short |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
| title_full |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
| title_fullStr |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
| title_full_unstemmed |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
| title_sort |
two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis |
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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2010 |
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Case report |
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http://dspace.nbuv.gov.ua/handle/123456789/32310 |
| citation_txt |
Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis / M. Dogan, G. Ozal, C. Ekinci, G. Utkan, Y. Urun, B. Yalcin, F. Icli // Experimental Oncology. — 2010. — Т. 32, № 4. — С. 277–279. — Біліогр.: 6 назв. — англ. |
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Experimental Oncology |
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2025-07-03T12:49:30Z |
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Experimental Oncology 32, 277–279, 2010 (December) 277
Isolated splenic metastasis is rare in colorectal
cancer. Malign melanoma, breast and ovarian cancers
are the most common solid tumors in which splenic
metastasis occurs [1]. Isolated splenic metastasis may
be synchronous or metachronous. The rates of iso-
lated splenic metastasis are reported as 4.4% for colon
cancer and 1.6% for rectum cancer. It is ge nerally
diagnosed while evaluating asymptomatic cancer
patients with increasing levels of carcinoembryonic
antigen (CEA). In this report, our aim is to report two
cases with atypical metastasis.
Case 1. A 58-year old male patient was admitted to
the hospital with ileus a year ago. Hemicolectomy was
performed after the diagnosis of colon carcinoma. His-
topathology revealed colon adenocarcinoma without
lymph node involvement (stage III). He was given adju-
vant 5-flurouracil (5-FU)-based chemotherapy. He had
a CEA level elevation [4.62 ng/mL (N: 0–3.4)] in blood
serum fifteen months after hemicolectomy without any
evidence of local or distant metastasis on evaluation.
However, a splenic mass was diagnosed 5 months
later. Splenectomy was performed, and histopathology
revealed the metastasis of colon adenocarcinoma in
the spleen. A 3.5 x 3 x 2.5 cm size tumor was located
just beneath the capsule of the spleen (Fig. 1, a, b).
Chemotherapy which consisted of 5-FU, leucovorine
(LV) and oxaliplatin (FOLFOX-4) was given. He had a
second relapse in the splenic localization (5.5 x 3 cm)
after 11 months of first relapse. An increased uptake of
18-fluorodeoxyglucose (18-FDG) was observed only
in this lesion with standardized uptake value (SUVmax)
of 11.7 on 18-FDG-positron emission computerized
tomography (18-FDG-PET-CT) (Fig. 2). Palliative che-
motherapy including 5-FU, LV, irinotecan (FOLFIRI) and
bevacizumab was started. The patient has no evidence
of progression for 7 months after the second relapse.
Case 2. A 51-year old male patient was admitted
with 2 months of constipation and hematochezia. He
was diagnosed as having rectal adenocarcinoma with
bilateral lung metastasis and a solitary nodular lesion
(1.8 x 1.5 cm) in the upper pole of right kidney. Renal
mass SUVmax was 13.1 on 18-FDG-PET-CT (Fig. 3).
Renal aspiration biopsy was performed to determine
TWO CASES WITH ATYPICAL METASTASIS IN COLORECTAL
CANCER: SPLENIC AND RENAL METASTASIS
M. Dogan1,*, G. Ozal1, C. Ekinci2, G. Utkan1, Y. Urun1, B. Yalcin1, F. Icli1
1Department of Medical Oncology, Cebeci Hospital, Ankara University School of Medicine, 06590,
Dikimevi, Ankara, Turkey
2Department of Pathology, Ankara University School of Medicine, 06590, Sıhhiye, Ankara, Turkey
Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal
cancer patients with isolated splenic metastasis, even after years of surgery in the literature. Aim: To report two colorectal cancer
cases with atypical metastasis. Results: The first patient was a 58-year old man who had isolated splenic metastasis after 20 months
of surgery. The other one was a 51-year old male patient with both lung and renal metastasis at rectal cancer diagnosis. Splenic
and renal metastases have been histopathologically documented in both of them. The first patient was given chemotherapy after
splenectomy. The other one had also multiple lung metastases besides renal metastasis. He received palliative chemotherapy.
Key Words: atypical metastasis, isolated splenic metastasis, renal metastasis.
Received:
*Correspondence: Fax: +903123192283;
E-mail: mutludogan1@yahoo.com
Abbreviations used: 5-FU — 5-flurouracil; 18-FDG — 18-fluorodeoxy-
glucose; CEA — carcinoembryonic antigen; CT — computerized to-
mography; PET-CT — positron emission computerized tomography.
Exp Oncol 2010
32, 4, 277–279
CASE REPORT
a
b
Fig. 1. Focal necrosis and atypical prismatic tumor cells with
abortive organization, hematoxylin and eosin staining — 10X
(a), 40X (b)
278 Experimental Oncology 32, 277–279, 2010 (December)
whether solitary renal mass was a synchronous renal
cell carcinoma or rectal adenocarcinoma metasta-
sis to the kidney. Cytology of renal mass revealed
colorectal adenocarcinoma metastasis (Fig. 4, a, b).
He was given FOLFIRI plus bevacizumab. Though the
CEA level decreased from 60.4 ng/mL to 3.93 ng/mL
after 6 cycles of chemotherapy, lung and renal lesions
remained stable on CT. Five months following the
last cycle of chemotherapy, metastatic lesion at left
sacroiliac joint and corpus of the second vertebrae
were diagnosed when he presented with pain on his
left hip radiating to left leg. He was given 2000 cGy of
radiotherapy to those lesions which relieved his pain.
Presently, he is at the ninth month of his follow-up.
Fig. 2. Metastatic lesion in the splenic localization (arrow) on
18-FDG-PET-CT at second relapse (SUVmax = 11.7)
Fig. 3. A solitary nodular lesion with a dimension of 18 x 15 mm
in the upper pole of right kidney on 18-FDG-PET-CT (SUVmax
= 13.1)
Atypical metastasis of colon cancer may occur
after many years from primary cancer diagnosis [2].
Splenic and renal metastases are very rare [2–4]. The
rarity of splenic metastasis was attributed to anatomic
characteristics like the sharp angle of the splenic ar-
tery with the celiac axis, rhythmic contractions by the
sinusoids and immune surveillance of the reticuloen-
dothelial system [5].
The splenic metastasis in our case was located
just beneath the capsule. Afferent lymphatics are
present only in the capsular, subcapsular and tra-
becular regions of the spleen. It was postulated that
this may explain the subcapsular location of splenic
metastasis [6].
Splenectomy should be the treatment of choice for
isolated splenic metastasis [5]. Though chemotherapy
following splenectomy may be preferred, the evidence
in the literature is inadequate to lead a definite con-
clusion related to its efficacy. Our patient was given
FOLFIRI plus bevacizumab following splenectomy
because of his relatively young age and good perfor-
mance status. Follow-up in our case is not long enough
to comment on the role of chemotherapy.
a
b
Fig. 4. Tumor infiltration including discohesive cells. Tu-
mor ce l ls had large, hyperchromat ic and moder-
ately differentiated pleomorphic nuclei with cyanophil-
ic cytoplasm (May-Grünwald Giemsa staining, 400X)
Solitary nodular renal lesions are generally thought
to be primary renal carcinoma. Multiple lung metas-
tases in addition to a solitary renal mass and multiple
lung metastases as in our case necessitate a renal
biopsy to differentiate these two primaries. Though the
prognosis in both situations is dismal, the treatments
of these primaries are specific which rationalizes the
renal biopsy procedure.
Positive PET scans in both cases suggest a con-
tributory role of it in distinguishing metastasis from
benign lesions.
REFERENCES
1. Rezgui L, Charfi M, Ben M’Rad S, et al. Isolated splenic
metastasis revealing colon cancer. Tunis Med 2003; 81: 832–4.
Experimental Oncology 32, 277–279, 2010 (December) 279
2. Place RJ. Isolated colon cancer metastasis to the spleen.
Am Surg 2001; 67: 454–7.
3. Brambilla E, Heck AA, Cao JG, et al. Isolated renal
metastasis after colon cancer. Can J Urol 2007; 14: 3649–50.
4. Aksu G, Fayda M, Sakar B, et al. Colon cancer with
isolated metastasis to the kidney at the time of initial diagnosis.
Int J Gastroint Cancer 2003; 34: 73–7.
5. Pisanu A, Ravarino A, Nieddu E, et al. Synchronous iso-
lated splenic metastasis from colon carcinoma and concomi-
tant splenic abscess: a case report and review of the literature.
World J Gastroenterol 2007; 13: 5516–20.
6. Cavallaro A, Modugno P, Specchia M, et al. Isolated
splenic metastasis from colon cancer. J Exp Clin Cancer Res
2004; 23: 143–6.
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