Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2020; 8(15): 3320-3328
Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3320
Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review
Li Hu, Ji-Yun Zhu, Lei Fang, Xiu-Chong Yu, Zhi-Long Yan
Li Hu, Ji-Yun Zhu, Lei Fang, Xiu-Chong Yu, Zhi-Long Yan, Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
Author contributions: Hu L and Yan ZL designed the manuscript and performed the surgery; Zhu JY reviewed the literature and contributed to drafting the manuscript; Fang L performed the radiology analyses; Yu XC performed the pathology analyses; Hu L wrote the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Long Yan, MD, Chief Doctor, Department of Gastrointestinal Surgery, Ningbo First Hospital, No. 59 Liuting Road, Ningbo 315000, Zhejiang Province, China. yanzhilong@nbu.edu.cn
Received: April 3, 2020
Peer-review started: April 3, 2020
First decision: May 15, 2020
Revised: May 27, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 6, 2020
Processing time: 125 Days and 6.4 Hours
Abstract
BACKGROUND

Isolated splenic metastasis is a rare clinical entity. Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.

CASE SUMMARY

We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously, and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen (CEA) and positron emission tomography (PET). However, multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging. Then the patient underwent total laparoscopic splenectomy. Local tumor recurrence and splenic metastasis from colorectal cancer (CRC) were found by postoperative pathology. Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2, APC exon16 and TP53 exon6 missense mutations, but no mutations of NRAS, KRAF, EGFR, ERBB2, MET, MLH1, MSH2 and MSH6 were detected. Chemotherapy and target therapy were administered after multiple disciplinary team (MDT) consultation, and no tumor recurrence has been observed to date. We also reviewed the literature by conducting a search of the PubMed database using the following key words: CRC, splenic metastasis, isolated, and review. We identified 34 relevant papers, which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.

CONCLUSION

Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery. In terms of overall survival and progression-free survival, MDT plays an important role in the entire process of disease management.

Keywords: Colon cancer; Isolated; Metachronous; Splenic metastasis; Literature review; Case report

Core tip: Isolated splenic metastasis is a rare clinical entity. We report a case of 48-year-old woman with isolated splenic metastasis 21 mo after radical colon adenocarcinoma resection. Close monitoring of serum carcinoembryonic antigen levels is crucial after colon adenocarcinoma surgery. Splenectomy seems to be the preferred treatment and multiple disciplinary team plays an important role in the entire process of disease management.