Abstract
A 77-year-old man was diagnosed with prostate cancer 8 years earlier. The patient was initially evaluated while on endocrine therapy for a left supraclavicular mass, and aspiration cytology was suspicious for prostate cancer metastases. In addition, upper GI endoscopy performed after eradication therapy for H. pylori gastritis showed gastric varices that were not present in the previous year. The platelet count was decreased to 74,000/μl. Abdominal CT showed a 4-cm mass at the splenic hilum. The patient was diagnosed with segmental portal hypertension due to the splenic hilar mass, and distal pancreatectomy and splenectomy were performed.
Macroscopic examination of the resected specimen showed a 25-mm, grayish-white, hard elastic mass. Histopathology showed positive PSA staining, and prostate cancer metastases were diagnosed. There was tumor microinvasion in the pancreatic and splenic parenchyma, with tumor emboli in the splenic vein. After surgery, the platelet count normalized, and upper GI endoscopy showed disappearance of the gastric varices.
Tumor metastases to the splenic hilum have seldom been reported, and the present patient is the only known case with segmental portal hypertension.
