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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 524-525
 

Unusual solitary splenic metastasis from pyriform fossa carcinoma detected by FDG-PET


1 Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Mumbai 400 012, India
2 Department of Pathology, Tata Memorial Hospital, Jerbai Wadia Road, Parel, Mumbai 400 012, India

Date of Web Publication10-Mar-2016

Correspondence Address:
Sandip Basu
Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Mumbai 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178396

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How to cite this article:
Abhyankar A, Desai SB, Asopa RV, Basu S. Unusual solitary splenic metastasis from pyriform fossa carcinoma detected by FDG-PET. Indian J Cancer 2015;52:524-5

How to cite this URL:
Abhyankar A, Desai SB, Asopa RV, Basu S. Unusual solitary splenic metastasis from pyriform fossa carcinoma detected by FDG-PET. Indian J Cancer [serial online] 2015 [cited 2019 Dec 5];52:524-5. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/524/178396


Sir,

Splenic metastasis is rare to be encountered in the setting of an oro-pharyngeal malignancy. Due to the improvement of modern imaging techniques and the long-term follow-up of patients with cancer, the incidence of the detection of splenic metastases are increasing.

[1] Usually they are seen in the setting of multi-visceral disseminated cancer.[2],[3] The most common primary sites of splenic metastasis are breast, lung, colorectal, and ovarian carcinomas, though occasional reports from other malignancies have been cited.[1] Differential diagnoses of space occupying lesion (SOL) in spleen include primary lymphoma, vascular tumors, and infectious lesions of the spleen. The prevalence was mainly obtained from autopsy series published before 1990 and ranged between 2.3% and 7.1%.[2] The relative rarity of splenic metastases might be explained by 2 main causes: (a) Mechanical factors impeding the splenic implantation of blood-borne cancer cells, that is, the constant flow of blood through the spleen and the rhythmic contraction of splenic capsule, the sharp angle of splenic artery branching from the celiac artery preventing large clumps of tumor cells from passing through, and the lack of afferent lymphatic vessels limiting lymphogenic metastases; (b) The inhibitory effect of the splenic microenvironment on the growth of metastatic cells.[3]

A 53 year old male, a known chronic alcoholic and tobacco chewer, presented with recent-onset hoarseness of voice and direct laryngoscopy showed growth in the right pyriform fossa (PFS) involving both the medial and lateral wall. CECT showed a soft tissue mass lesion in supraglottis and lesion on right PFS destroying thyroid cartilage. Biopsy of right PFS lesion showed moderately differentiated squamous cell carcinoma. The clinical staging was cT4N0M0. Repeat CT scan following chemo-radiotherapy demonstrated post-RT changes in neck and a mass lesion of 2.5 × 3.3 cm in Rt. PFS but no lymphdenopathy. Repeat DL showed post RT changes. Patient was considered for wide excision of the recurrence and was referred for whole body PET for disease evaluation. FDG-PET [Figure 1]a and [Figure 1]b showed intense tracer uptake at the primary site and a large oval area of intense tracer uptake was seen in the spleen. In addition, foci of intense tracer uptake was noted in the right lung at the junction of upper and middle lobe antero-medially, lower edge of the upper lobe of the right lung postero-laterally and the lower lobe of the left lung posteriorly. In view of the large focal lesion noted in spleen (which is otherwise a rare site of metastasis in oropharyngeal carcinoma), an USG abdomen [Figure 2] was undertaken which showed a large well defined oval hypo echoic area of 4.3 × 4.1 cm size in the spleen suggesting either infection or metastatsis. A USG guided FNAC proved this to be metastatic squamous cell carcinoma [Figure 3]a and [Figure 3]b consistent with the known primary of PFS.
Figure 1: (a) Whole body FDG PET demonstrates scan (MIP image), done 45 minutes after the intravenous injection of 475 MBq of [18] F-FDG, shows multiple foci of intense tracer uptake in bilateral lungs (Lt.>Rt.), and in the neck (the primary site). A large oval area of intense tracer uptake is noted in the left hypo-chondriac region in the spleen, (b) The coronal sections of the FDG-PET of the patient showing the lesion distribution in bilateral lungs, pharynx and the spleen

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Figure 2: The USG abdomen study showing the large capsulated space occupying lesion in the spleen

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Figure 3: (a) Splenic aspirate revealed clusters of metastatic squamous carcinoma (PAP, 200x), (b) Splenic aspirate revealed clusters of metastatic squamous carcinoma (PAP, 400x)

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Splenic metastases, at times, pose a diagnostic dilemma with other primary or benign lesions of the spleen particularly when they present as solitary lesion in patients with a history of malignant disease. Fine-needle aspiration and percutaneous biopsy of splenic lesions are useful in most cases in establishing the correct diagnosis.

 
 » References Top

1.
Gupta T, Nair N, Fuke P, Bedre G, Basu S, Shrivastava SK. Splenic metastases from cervical carcinoma: A case report. Int J Gynecol Cancer 2006;16:911-4.  Back to cited text no. 1
    
2.
De Wilt JH, McCarthy WH, Thompson JF. Surgical treatment of splenic metastases in patients with melanoma. J Am Coll Surg 2003;197:38-43.  Back to cited text no. 2
    
3.
Berge T. Splenic metastases: Frequencies and patterns. Acta Pathol Micro-biol Scand 1974;82:499-506.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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