CASE PRESENTATION:
A 71-year-old ex-serviceman was referred to the Department of Surgery
from the Department of Oncology with a history of splenic metastasis
secondary to colorectal carcinoma. During the initial visit to our
hospital two years ago, he presented with complaints of no passage of
stool and flatus, abdominal pain, and tenderness, consistent with
peritonitis, which had persisted for three days. Immediate resuscitation
and investigations were performed, including a computed tomography (CT)
scan that revealed an obstructing growth in the sigmoid colon.
Given the patient’s clinical presentation of abdominal pain and
tenderness, suggestive of peritonitis, he underwent emergency
laparotomy, during which a sigmoid mass was excised, and a loop
ileostomy was performed. The postoperative recovery was uneventful.
Histopathological examination of the specimen revealed a
well-differentiated adenocarcinoma of the sigmoid, perforating the
serosa (pT4), with perineural invasion. The margins were negative, and
four out of the 16 lymph nodes were involved, leading to the
classification of the tumor as stage III (pT4bN1b, AJCC). The patient
subsequently underwent ileostomy reversal two months after the surgery.
The patient was discharged and referred to the Department of
Oncomedicine for adjuvant chemotherapy.
Two years later, a follow-up CT scan found metastasis in the spleen. PET
CT of the whole body with contrast revealed splenic metastasis with
multiple FDG avid hypodense lesions, the largest measuring 6.6X4.3 cm
with an SUV max of 6.1 cm Fig1 . However, no recurrence was
detected along the anastomotic site in the sigmoid, and no bony or bone
marrow lesions were found.Any other remote organ metastases were not
found by both CT and PET scanning. Clinical examination did not reveal
any palpable spleen, and the patient subsequently underwent laparoscopic
splenectomy Fig 2 . The surgical findings in this case indicate
that the metastatic tumor was localized to the spleen without any
capsule invasion macroscopically. There were also no metastases detected
in other intra-abdominal organs or lymph nodes at splenic hilus or
para-aortic site. Therefore, lymphadenectomy was not performed during
the operation.The postoperative period was uneventful, and
post-splenectomy vaccination and antibiotics were initiated.
Histopathological report revealed metastatic adenocarcinoma with no
capsule invasion Fig 3 . Adjuvant chemotherapy was started, and
at the one-month follow-up, the patient was doing well.