Splenic metastases in patients with portal hypertension

Involvement of the spleen in the course of solid tumours usually occurs in patients with widespread disease and multiple organ involvement [ 11. We describe 2 cases in which splenic metastases were the frrst evidence of distant disease. Both patients had liver cirrhosis, and a possible haemodynamic mechanism favouring spleen colonisation is discussed. In a 64-year-old woman (patient 1) with a 7 year history of chronic active hepatitis progressing to cirrhosis, a large irregular pelvic mass (10 cm) and a focal lesion of the spleen were diagnosed by computed tomography (CT) scan. Serum CA125 antigen was greatly increased, and tie needle biopsies under ultrasound guidance disclosed the diagnosis of ovarian adenocarcinema with splenic metastasis. Six cycles of chemotherapy (PEC (cisplatin, epirubicin and cyclophosphamide) regimen) were administered. Due to a very good partial response to chemotherapy, the patient underwent cytoreductive surgery (hysterectomy plus bilateral salpingo-oophorectomy, omentectomy, splenectomy, sigmoid colon resection) which confirmed the presence of left ovarian carcinoma infIltrating the sigmoid colon and a solitary splenic metastasis. No further chemotherapy was given, and the patient was well until 7 months later when pelvic wall recurrence was diagnosed. A 65year-old man (patient 2) underwent surgical resection for adenocarcinoma of the descending colon. The patient was HCV (hepatitis C virus) positive and a liver biopsy performed during intervention disclosed cirrhosis. Adjuvant chemotherapy was given (S-fluorouracil plus leucovorin for eight cycles). The patient was well until 18 months after surgery when a large spleen lesion (7 cm) was documented by uhrasonography. The patient was referred for surgery. Splenectomy was performed confirming the presence of a secondary lesion from adenocarcinoma of the gastrointestinal (GI) tract with no other abdominal organ involvement. No further treatment was given and the patient is alive and well with no signs of recurrence at 20 months from surgery. Metastasis to the spleen from various neoplasms is very rare. In autopsy studies [2], splenic involvement is found in approximately 7% of patients, breast cancer, lung cancer and melanoma being the most common sources. Splenic metastases are usually part of widespread abdominal disease with lymph node involvement, and it has been suggested that they arise from