Solitary splenic metastasis of squamous lung cancer: a case report
© Chloros et al; licensee BioMed Central Ltd. 2009
Received: 2 October 2009
Accepted: 25 November 2009
Published: 25 November 2009
Lung cancer is the second commonest malignant tumour, with its splenic metastasis being a rare event.
We report an exceedingly rare case of a moderate-to-low differentiation squamous cell lung carcinoma in a middle-aged man with a large solitary splenic metastasis detected simultaneously with the primary tumour. Surgical removal of both the primary tumour and the solitary splenic metastasis offered the patient the best treatment option.
The significance of the present case lies on the one hand in the appearance of a large solitary splenic metastasis from a squamous lung cancer at the time of its initial presentation and on the other in the successful excision of both lesions simultaneously.
Lung cancer is the second commonest malignant tumour, with its splenic metastasis being a rare event . When present, it is diagnosed more often at autopsy  and it is usually accompanied with metastases to other abdominal organs [1, 2]. We report an exceedingly rare case of a squamous cell lung carcinoma in a middle-aged man with a large solitary splenic metastasis detected simultaneously with the primary tumour.
Bronchoscopic examination revealed a mass within the posterior segmental bronchus of the right upper lobe and biopsy confirmed the diagnosis of squamous carcinoma of moderate-to-low differentiation. A routine workup was negative for liver, adrenal, brain or bone metastatic lesions. A fine needle biopsy of the spleen under radiological guidance confirmed the diagnosis of metastasis from the primary lung carcinoma. The TNM stage of disease was cT2N0M1 (stage IV). Respiratory function tests were within normal limits.
Metastases from lung cancer to the spleen develop usually at advanced cancer stages in the context of disseminated abdominal visceral lesions, while solitary splenic metastasis is extremely rare [3, 4]. More unusual is the discovery of a solitary metastasis at the time of the initial lung cancer diagnosis [5, 6]. The importance of the present case lies (a) in the appearance of a large solitary splenic metastasis from a moderate-to-low squamous right lung cancer at the time of its initial presentation and (b) in the successful excision of both lesions simultaneously.
Diagnosis can be achieved with splenectomy or with less invasive methods such as fine needle aspiration or transcutaneous biopsy, as in our patient case, with high probability of success and very low complication rate (less than 2%) . The rarity of splenic metastases may be related to the inhibitory effect of the immunologically well-equipped splenic microenvironment on the growth of metastatic cells, given that micro-metastatic dissemination occurs early in the course of malignant disease and is not affected by mechanical factors .
Surgical removal of the solitary splenic metastasis is considered the best treatment option. With this aggressive practice, long survival attainment is possible  even without adjuvant chemotherapy, which does not appear to be superior to surgery alone .
Written informed consent was obtained from the next of kin for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this Journal.
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