Abstract
The patient was an 80-year-old man. Previous history included a right lower lobectomy for a lung adenocarcinoma accompanied with partial parietal pleurectomy on September 2010. The tumor was a poorly differentiated acinar adenocarcinoma with abundant necrotic lesions. One year later, as a metastatic work-up, an 18-fluorodeoxyglucose positron emission tomography (FDG-PET) scan was performed. It showed abnormal uptakes in the spleen, without other organ abnormalities. Abdominal CT scan with contrast enhancement showed a 4.5×4.0-cm splenic tumor. Clinically, we diagnosed it a solitary splenic metastasis from primary lung cancer, and recommended the patient to have a splenectomy. However, he elected to have the splenic lesion followed with subsequent CT scans rather than undergo surgery. Six months later, a follow-up CT scan showed the splenic lesion had enlarged to 8.0×6.5-cm, and splenectomy was advised again. On June 2012, he underwent exploratory laparotomy and splenectomy. There was no other intra-abdominal pathology evident. The resected spleen was occupied with the tumor, and it was diagnosed as a poorly differentiated acinar adenocarcinoma, corresponding to the histological findings of the primary lung cancer. Splenic metastases from lung cancer are considered very rare. In most cases, these represent diffuse disease and widespread hematologic dissemination. Isolated splenic metastases in the absence of widespread disease are considered extremely rare. We report such a rare case and provide a review of the literature.
