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LETTER TO EDITOR  
Year : 2015  |  Volume : 58  |  Issue : 2  |  Page : 256-258
Splenic metastasis arising from recurrent nasopharyngeal carcinoma: A rare case report


1 Department of Surgery, College of Medicine, Alfaisal University, Riyadh; Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
2 Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
3 Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
4 Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
5 Department of Surgical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

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Date of Web Publication17-Apr-2015
 

How to cite this article:
Abu-Zaid A, Qureshi S, Mina S, Safwat Y, Sulaimanie S, Azzam A, Mohammed S, Amin T. Splenic metastasis arising from recurrent nasopharyngeal carcinoma: A rare case report. Indian J Pathol Microbiol 2015;58:256-8

How to cite this URL:
Abu-Zaid A, Qureshi S, Mina S, Safwat Y, Sulaimanie S, Azzam A, Mohammed S, Amin T. Splenic metastasis arising from recurrent nasopharyngeal carcinoma: A rare case report. Indian J Pathol Microbiol [serial online] 2015 [cited 2020 Oct 20];58:256-8. Available from: https://www.ijpmonline.org/text.asp?2015/58/2/256/155350


Editor,

A 26-year-old male presented with a 3 weeks history of left upper-quadrant pain. Past medical and surgical histories were remarkable for nasopharyngeal carcinoma (NPC), status postresection and chemo-radiation therapy with complete remission 6 years ago.

Physical examination exhibited a moderately tender splenomegaly.

All laboratory tests including complete blood count, renal, hepatic, coagulation, bone, and tumor marker (CA-125, CA 15-3, alpha-fetoprotein, and carcinoembryonic antigen) profiles were normal.

Whole-body contrast-enhanced computed tomography (CT) scan showed a 5.8 cm 5.5 cm, nonenhancing mass with a central area of necrosis involving the spleen [Figure 1]a. There was a single 1 cm lymph-node involving the splenic hilum. No evidence of distant metastasis was identified elsewhere.
Figure 1: (a) Axial contrast-enhanced computed tomography scan of abdomen showing a 5.8 cm × 5.5 cm, nonenhancing mass with a central area of necrosis involving the spleen. (b) Gross examination of the splenectomy mass showing two attached segments of fibro-fatty tissues. (c) Microscopic examination of the resected splenectomy mass showing syncytial arrangement of undifferentiated atypical large cells with vesicular chromatin and prominent nucleoli (H and E, magnification power, ×60). (d) Immunohistochemical examination of the resected splenectomy mass showing the neoplastic cells staining positive for cytokeratin AE1/AE3 (magnification power, ×60)


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Ultrasound-guided fine-needle aspiration (FNA) biopsy of the splenic lesion was performed successfully, and histopathological examination showed metastatic NPC.

In consideration of symptomatic splenomegaly, patient underwent elective splenectomy.

Grossly [Figure 1]b, the splenectomy mass was black-colored, weighted 64 g and measured 6.0 cm 3.0 cm 3.5 cm. The mass consisted of two attached segments of fibro-fatty tissues. Serial sectioning of the fibro-fatty tissues revealed two lymph-nodes measuring 1 cm and 0.6 cm in the greatest dimensions; otherwise unremarkable. Serial sectioning of the spleen revealed a multi-nodular gray-white soft tumor measuring 3 cm 3 cm 2.5 cm.

Microscopically, the splenectomy mass showed syncytial arrangement of undifferentiated atypical large cells with vesicular chromatin and prominent nucleoli [Figure 1]c. Immunohistochemically, the neoplastic cells stained positive for cytokeratin AE1/AE3 [Figure 1]d.

A final histopathological diagnosis of metastatic undifferentiated NPC involving the spleen was established.

Patient had an uneventful recovery following surgery. At a postoperative 12 months follow-up, patient was completely asymptomatic, and there was no radiological evidence of tumor recurrence.

Splenic metastases arising from NPC are exceedingly uncommon. Until date, only seven cases have been reported. [1],[2],[3]

Splenic metastases are commonly identified incidentally by conventional ultrasonography or CT scans during routine follow-up or tumor work-up of susceptible cancer patients. This may be largely attributed to the failure of clinical detection as more than 60% of susceptible patients are asymptomatic. [4]

In addition, anatomical and functional factors contribute to the comparative rarity of splenic metastasis. Such anatomical factors include: The highly vascular nature of spleen with continuous blood flow, innate periodic contraction of splenic capsule, sharp-angled architecture of splenic artery and absence of splenic afferent lymphatic vessels - all of which serve to limit hematogenous and lymphogenous metastatic access of neoplastic cells to spleen. [4] Functionally, the abundance of lymphoid tissues in spleen greatly increases its anti-tumor immunity against metastatic neoplastic attacks. [4]

In short, although exceedingly rare, splenic metastasis arising from NPC should be considered in the differential diagnosis of any patient with known history of primary/recurrent NPC presenting to medical attention with abdominal pain or splenic mass on radiology. Splenic biopsy through FNA along with immunohistochemical analysis is useful in establishing the definitive diagnosis in most cases with acceptable morbidity. [4] NPC cells typically stain positive for cytokeratin AE1, which is highly sensitive and specific. [5] Splenectomy is curative and should be performed in symptomatic patients for palliative purposes to improve the quality of life and/or when the risk of splenic rupture is high. [4]

 
   References Top

1.
Siniluoto T, Päivänsalo M, Lähde S. Ultrasonography of splenic metastases. Acta Radiol 1989;30:463-6.  Back to cited text no. 1
    
2.
Lam KY, Tang V. Metastatic tumors to the spleen: A 25-year clinicopathologic study. Arch Pathol Lab Med 2000;124:526-30.  Back to cited text no. 2
    
3.
Radhakrishnan V, Thulkar S, Karunanithi S, Tanveer N, Bakhshi S. Nasopharyngeal carcinoma with splenic and cystic liver metastases in a pediatric patient: 18F-FDG PET-CT findings. Pediatr Radiol 2010;40 Suppl 1:S79-82.  Back to cited text no. 3
    
4.
Compérat E, Bardier-Dupas A, Camparo P, Capron F, Charlotte F. Splenic metastases: Clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med 2007;131:965-9.  Back to cited text no. 4
    
5.
Shi SR, Goodman ML, Bhan AK, Pilch BZ, Chen LB, Sun TT. Immunohistochemical study of nasopharyngeal carcinoma using monoclonal keratin antibodies. Am J Pathol 1984;117:53-63.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Ahmed Abu-Zaid
College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.155350

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