Hemangiosarcoma ; pathology ; Humans ; Liver Neoplasms ; pathology ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Pelvic Neoplasms ; secondary ; Spinal Neoplasms ; secondary ; Splenic Neoplasms ; secondary

Isolated splenic metastasis arising from colorectal carcinoma is very rare and there has been only 6 cases reported in the English literature. A new case is esented, and its possible pathogenesis was considered with previously reported ses. A 65-year-old male patient had received a right hemicolectomy for cending colon cancer 36 months earlier. He was followed up regularly with rial measurement of serum carcinoembryonic antigen (CEA). Rising serum CEA was scovered from 33 months postoperatively and CT revealed an isolated splenic tastasis. He therefore underwent splenectomy, which was proven to be a tastatic adenocarcinoma with similar histological feature to the original mor. As all reported cases showed elevated serum CEA at the time of tastasis, isolated splenic metastasis might be associated with CEA in regard its biological functions of immunosuppression and adhesion.
Adenocarcinoma/surgery ; Adenocarcinoma/secondary* ; Adenocarcinoma/pathology ; Adenocarcinoma/blood ; Aged ; Carcinoembryonic Antigen/blood ; Case Report ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology* ; Colorectal Neoplasms/blood ; Human ; Male ; Splenic Neoplasms/surgery ; Splenic Neoplasms/secondary* ; Splenic Neoplasms/blood ; Tomography Scanners, X-Ray Computed

Gastrointestinal stromal tumor (GIST) represents the most common intramural mesenchymal tumor of the gastrointestinal tract, but the synchronous occurrence of GIST in the stomach and gynecological cancer is rare. We present a unique case of a 56-year-old female patient who was diagnosed with the synchronous development of GIST and an isolated parenchymal splenic metastasis of ovarian cancer. She underwent a wide local excision of gastric lesions with splenectomy. A morphological (histological and immunohistochemical) study established a spindle-cell type of gastrointestinal tumor that expressed CD117, and a parenchymal recurrence of ovarian papillary serous adenocarcinoma. The patient has remained alive and disease-free for 30 months since the last operation. A small GIST concomitant with an isolated parenchymal splenic metastasis of ovarian cancer is rarely encountered. The coexistence of GIST with other malignancies constitutes an intriguing oncologic model. Surgeons are advised to be alert against possible primary GIST accompanying other neoplasms.
Female ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; secondary ; Humans ; Middle Aged ; Ovarian Neoplasms ; complications ; Radiography ; Splenic Neoplasms ; secondary

OBJECTIVETo study the clinicopathologic features and diagnosis of metastatic carcinoma to the spleen (MCS).

METHODSFour patients (1 man and 3 women, mean age 43.5 years) with MCS were analyzed clinicopathologically.

RESULTSThe four MCS patients accounted for 1.3% of 308 patients having spleen biopsy from 1959 to 1999. Their chief presentations were pain and mass in the left upper quadrant of the abdomen. The mass was located in the upper pole of the spleen (1 patient), the lower pole of the spleen (2), or the lower pole and hilum of the spleen (1). Macroscopically, all of the lesions were nodular. Histologic type of these MCSs included acinar cell carcinoma of the pancreas (2 patients), transverse colon adenocarcinoma (1), and hepatic cell carcinoma (1). Clinically, 1 patient was diagnosed as having MCS and 3 were misdiagnosed. According to Chinese literature, the clinicopathologic features of MCS were as follows: (1) 66.7% of the patients with MCS were aged 30 approximately 60 years, with a mean of 51.2 years. (2) 76.3% of the patients presented with pain in the left upper quadrant of the abdomen and 63.2% with splenomegaly and splenic masses. (3) Macroscopically, nodular lesions accounted for 68.4%. (4) Microscopically, 84.2% of the lesions were adenocarcinomas and 70.3% originated from carcinomas of the colon, liver, ovary and pancreas. (5) B-mode ultrasonography and/or CT showed occupying lesions or masses in the spleen in 76.7%, and MCS in 11.8%. (6) Clinically, 73.7% of the patients were misdiagnosed.

CONCLUSIONSMCS is uncommon but its clinical misdiagnosis rate is high. Image examination is of value in clinical diagnosis. Cooperation of clinicians and pathologists may enhance the diagnostic level of MCS.

Adult ; Female ; Humans ; Male ; Middle Aged ; Splenic Neoplasms ; diagnosis ; pathology ; secondary

OBJECTIVETo study the clinicopathologic characteristics of metastatic carcinomas to the spleen.

METHODSSixteen cases of metastatic carcinoma to the spleen were retrieved from archival clinical, surgical pathology and autopsy records. The demographic data (including sex and age of patients), clinical symptoms, primary sites, tumor histologic types, gross appearance of spleen and growth patterns within the spleen were analyzed.

RESULTSAmong the 16 patients studied, 12 were males and 4 were females. The male predilection was obvious. The age ranged from 48 to 90 years, the median age 66.5 years. Major clinical symptoms included discomfort in the left upper quadrant, pain, emaciation and loss of appetite. Splenomegaly was noted in some patients and computerized tomography could show space-occupying lesions in the spleen. In general, lung was the most common primary site for splenic metastasis and accounted for 43.8% of all cases (7/16). In male patients, primary lung tumor was found in 50.0% cases (6/12). On the other hand, primary ovarian tumor was commonly seen in females (2/4). Histologically, undifferentiated carcinoma of lung was frequently encountered (25.0%, 4/16), including 3 cases of small cell undifferentiated carcinoma and 1 case of large cell undifferentiated carcinoma. Other histologic tumor types included bronchioloalveolar carcinoma (2 cases), colonic adenocarcinoma (2 cases), ovarian serous papillary adenocarcinoma (2 cases), and prostatic adenocarcinoma (2 cases). The commonest histologic tumor type found in male patients was pulmonary undifferentiated carcinoma. The growth patterns of metastatic carcinoma in spleen included nodular, diffuse and multinodular. Most cases presented as a single splenic nodule. Sometimes, tumors with high metastatic potential (5/16) showed diffuse and multinodular growth patterns. Examples of these tumors included small cell undifferentiated carcinoma (3 cases), pulmonary adenocarcinoma (1 case) and prostatic adenocarcinoma (1 case).

CONCLUSIONSMetastatic carcinoma to the spleen is rare. Understanding of the clinicopathologic characteristics is helpful in guiding clinical management and pathologic diagnosis.

Adenocarcinoma ; secondary ; Adenocarcinoma, Bronchiolo-Alveolar ; secondary ; Aged ; Aged, 80 and over ; Carcinoma, Small Cell ; secondary ; Colonic Neoplasms ; pathology ; Cystadenocarcinoma, Serous ; secondary ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Ovarian Neoplasms ; pathology ; Prostatic Neoplasms ; pathology ; Spleen ; pathology ; Splenic Neoplasms ; secondary

Adenocarcinoma ; drug therapy ; pathology ; secondary ; surgery ; Chemotherapy, Adjuvant ; Endometrial Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Humans ; Hysterectomy ; Middle Aged ; Splenectomy ; Splenic Neoplasms ; drug therapy ; pathology ; secondary ; surgery

OBJECTIVETo study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery.

METHODSPancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.

RESULTSAmong these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly.

CONCLUSIONSThe surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).

Adult ; Aged ; Female ; Humans ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Lymphatic System ; physiopathology ; Male ; Methylene Blue ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms ; secondary ; surgery ; Postoperative Complications ; Splenic Neoplasms ; secondary ; surgery ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the feasibility, safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) of splenic tumors.

METHODSSeven patients with 8 pathologically confirmed splenic tumors (including 2 metastases from the ovary and 4 from the lung, gastric adenocarcinoma, hepatocellular carcinoma, or rectal carcinoma; 1 hemangioma and 1 inflammatory pseudotumor) with sizes ranging from 1.3 to 6.2 cm (mean 3.1 ± 1.9 cm) were treated with MWA. A cooled shaft needle antenna was percutaneously inserted into the tumor under ultrasound guidance. A thermocouple was placed about 0.5 cm away from the tumor to monitor the temperature in real time during the ablation. The microwave emitting power was set at 50-60 W. The treatment efficacy was assessed by contrast-enhanced imaging at 1, 3 and 6 months following the procedure, and every 6 months thereafter.

RESULTSAll the tumors were completely ablated in a single session and no complications occurred. No local tumor progression was observed during a median follow up time of 13 months (4 to 92 months). The ablation zone, well defined on contrast-enhanced imaging, was gradually reduced with time. A new metastatic lesion was detected in the spleen at 11 months after the ablation in a ovarian carcinoma patient and was successfully treated by a second MWA. The post-ablation survival of the patients with splenic metastasis was 13 months (range 4 to 92 months). No complications other than fever and abdominal pain were observed in these patients.

CONCLUSIONUltrasound-guided percutaneous MWA is a safe and effective minimally-invasive technique for treatment of splenic tumors in selected patients.

Adenocarcinoma ; pathology ; Carcinoma, Hepatocellular ; pathology ; Catheter Ablation ; Contrast Media ; Female ; Humans ; Liver Neoplasms ; pathology ; Microwaves ; Minimally Invasive Surgical Procedures ; Ovarian Neoplasms ; pathology ; Splenic Neoplasms ; diagnostic imaging ; radiotherapy ; secondary ; Stomach Neoplasms ; pathology ; Treatment Outcome ; Ultrasonography

OBJECTIVE: Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC. METHODS: This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed. RESULTS: All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively. CONCLUSION: The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.
Adult ; Aged ; *Cytoreduction Surgical Procedures ; Disease-Free Survival ; Female ; Humans ; Middle Aged ; Neoplasms, Glandular and Epithelial/mortality/pathology/*surgery ; Ovarian Neoplasms/mortality/pathology/*surgery ; *Pancreatectomy/adverse effects ; Postoperative Complications/epidemiology/therapy ; *Splenectomy/adverse effects ; Splenic Neoplasms/pathology/*secondary/*surgery

OBJECTIVEDue to their lower risk for induction of resistance, antimicrobial peptides with selective anticancer effect could be developed into a new generation of anticancer drugs. We conjugated an antimicrobial peptide with tumor-targeting peptides (TMTP1) to explore whether it has inhibiting effect on the progression and metastasis of transplanted prostate cancer and gastric cancer in nude mice.

METHODSSubcutaneously transplanted human prostate cancer and orthotopically transplanted human gastric cancer in nude mice were prepared. 50 µmol/L PBS (control group), 50 µmol/L TMTP1 (TMTP1 group) or 50 µmol/L TMTP1-GG-D(KLAKLAK)(2) (treatment group) were injected i.p. to the three groups of nude mice, respectively. The binding ability of the novel fusion polypeptide TMTP1-GG-D(KLAKLAK)(2) to the tumors and its antitumor effect were assessed by measurement of tumor volume, histopathological examination of the tumor tissues, testing apoptosis index of tumor cells with TUNEL staining, and survival curve plotting of the mice.

RESULTSThe median survival time of subcutaneous prostate cancer-bearing mice was 50 days in the control group, 55 days in the TMTP1 group, and 70 days in the TMTP1-GG-D(KLAKLAK)(2) group (P < 0.05). The median survival time of the subcutaneous gastric cancer-bearing mice was 25 days in the control group, 30 days in the TMTP1 group, and 45 days in the TMTP1-GG-D(KLAKLAK)(2) group (P < 0.01). The tumor volume in the subcutaneous prostate cancer-bearing mice was (2.5 ± 0.3)cm(3) in the control group, (1.8 ± 0.2) cm(3) in the TMTP1 group, and (0.3 ± 0.1)cm(3) in the TMTP1-GG-D(KLAKLAK)(2) group (P < 0.01). The tumor volume of the subcutaneous gastric cancer-bearing mice was (3.8 ± 0.4) cm(3) in the control group, (3.2 ± 0.2)cm(3) in the TMTP1 group, and (0.4 ± 0.1) cm(3) in the TMTP1-GG-D(KLAKLAK)(2) group (P < 0.01). Large tumors were observed in the stomach of the orthotopic gastric cancer-bearing mice of the control and TMTP1 groups. The tumor volume of the TMTP1-GG-D(KLAKLAK)(2) group was obviously reduced. White metastases in the liver, spleen and abdominal wall were observed in the control and TMTP1 groups (P < 0.01). TUNEL staining revealed that the apoptosis index of the control group was (31.9 ± 1.5)%, TMTP1 group (37.2 ± 2.3)% and TMTP1-GG-D(KLAKLAK)(2) group (69.7 ± 2.1)% (P < 0.01).

CONCLUSIONSThe results of our study demonstrate that the novel fusion peptide of antimicriobial peptide conjugated with TMTP1 can effectively inhibit tumor progression and metastasis, therefore, is promising to be a novel effective anticancer drug.

Animals ; Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Line, Tumor ; Humans ; Liver Neoplasms ; secondary ; Male ; Mice ; Mice, Nude ; Neoplasm Transplantation ; Oligopeptides ; pharmacology ; Peptides ; pharmacology ; Prostatic Neoplasms ; pathology ; Splenic Neoplasms ; secondary ; Stomach Neoplasms ; pathology ; Tumor Burden ; drug effects ; Xenograft Model Antitumor Assays