Solitary metastasis to spleen are extremely rare and usually diagnosed during autopsy. Isolated solitary splenic metastases is very much rare situation while splenic involvement is more common in cancer patients
with multiple organ metastases.[
1-
3] In autopsy examination studies performed by Lam and his collegues it was found that isolated splenic metastasis had been 5.3% in all cancer types.[
3] Metastases to spleen are usually from breast, lung, colorectal, overian, gastric carcinomas and also from melanomas.[
3-
5] Adenocarcinoma is the type of cancer in which metastases to spleen are most commonly seen.[
2-
4] Physical barrier effect of splenic capsule, spleen’s ritmic contractility, sharp curl of splenic artery complicate the constitution of tumor embolism. Lack of afferent lymphatics and antitumor activity in relation with the dense lymphoid tissue concentration was reported to decrease the possibility of tumor metastases to spleen.[
3,
4]
Splenic metastases appear usually in the older ages, generally in the seventh decade of life.[3,4] They are usually non-symptomatic and only 8% is determined as symptomatic. The symptomatic patients are frequently females and teenagers with pain and splenomegaly.[3]
Kinoshita et al.[2] detected 15 (5.6%) splenic metastases in the series of 267 lung cancer autopsy. Avarage 3.1 metastases in other organs and 2.5 metastases in lymph nodes have been detected in the existence of splenic metastases of lung cancer.[1] Isolated solitary splenic involvement of lung cancer is extremely rare. Only 8 cases had been reported until today.[1] As it has been seen in our case, metastasis to spleen from left lung is more common than the right lung.[2] The most probable reason of this is left lung's higher blood flow ratio than the right one.[1]
Primary lung cancer with brain or adrenal solitary metastasis, lung cancer surgery is performed following metastasectomy . In recent studies it has been presented that splenectomy operation should be the choice in splenic metatases.[1,2] Surgery was planned because of the fact that spleen is a potentially resectable organ.
Since, practically it is applicable to reach to spleen through the left diaphragm, both organs could be resected through a single skin incision with left thoracotomy and left phrenotomy as published in the literature.[4,6]
The aim of splenectomy in isolated solitary splenic metastases from lung cancer is to protect other organs from metastases, as well as protecting from complications such as pain due to splenomegaly, splenic rupture and splenic vein thrombosis, which can occur due to splenomegaly. Thus improvement in survival could be expected. After the resection for primary lung cancer and isolated solitary splenic metastasis, survival in 2 patients was reported as 49 months and 8 years.[1]
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