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A report of laryngeal adenocystic carcinoma metastatic to the spleen and the role of splenectomy in the management of metastatic disease: a case report.

Murray BW, Lyons LC, Mancino AT, Huerta S - J Med Case Rep (2010)

Bottom Line: A review of the literature did not yield any other such incidents.He initially developed asynchronous pulmonary metastases, which were resected.A splenectomy effectively addresses symptoms and serves as a cytoreduction modality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dallas VA Medical Center, Surgical Services (112), 4500 S Lancaster Road, Dallas, TX 75216, USA. brycew.murray@va.gov.

ABSTRACT

Introduction: Adenoid cystic carcinoma (ACC) of the larynx is a rare malignancy characterized by an indolent course and late pulmonary metastases. Metastases from the larynx to the spleen are an unusual event. In the present report, we discuss a patient with adenoid cystic carcinoma of the larynx metastatic to the spleen. A review of the literature did not yield any other such incidents. We review the clinical presentation and course of adenoid cystic carcinoma, as well as the role of splenectomy for metastases.

Case presentation: We present a case of laryngeal adenoid cystic carcinoma in a 26-year-old Caucasian man treated with total laryngectomy and ionizing radiation. He initially developed asynchronous pulmonary metastases, which were resected. Our patient subsequently presented with a symptomatic splenic lesion consistent with metastatic disease, for which he underwent laparoscopic splenectomy.

Conclusions: Splenectomy might be indicated for isolated metastases. A splenectomy effectively addresses symptoms and serves as a cytoreduction modality.

No MeSH data available.


Related in: MedlinePlus

Gross pathologic specimen (A), and microscopic view demonstrating characteristic cribriform pattern abutting splenic capsule (B).
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Figure 2: Gross pathologic specimen (A), and microscopic view demonstrating characteristic cribriform pattern abutting splenic capsule (B).

Mentions: During follow up a computed tomography (CT) scan of the chest demonstrated bilateral lung nodules, which were consistent with metastatic disease (Figure 1B). However, there were no symptoms attributable to these lesions. The CT scan also demonstrated a lesion in the spleen that measured 4cm and was approximately 1mm from the splenic capsule (Figure 1A). He was referred to the surgical service when a follow up CT scan of the abdomen three months later demonstrated progression in size of the lesion by 1cm and our patient complained of left upper quadrant abdominal discomfort. There was no evidence of other intra-abdominal disease. Due to the progression in size of the splenic lesion, its proximity to the capsule with potential complications of rupture or local advancement, and in light of our patient's symptoms the decision was made to proceed with laparoscopic splenectomy. He was given appropriate pre-operative immunization. At the time of surgery, there was no evidence of other intra-abdominal disease. The spleen (Figure 2A) was removed intact through an enlarged port site incision. Pathologic examination (Figure 2B) showed a 5.2 × 4.3 × 4cm single metastatic nodule within 0.1cm from the capsule. The mass shows mucoid areas in the center and microscopically had features characteristic of adenoid cystic carcinoma with a predominant cribriform growth pattern. He had a routine convalescence, and is currently alive and well.


A report of laryngeal adenocystic carcinoma metastatic to the spleen and the role of splenectomy in the management of metastatic disease: a case report.

Murray BW, Lyons LC, Mancino AT, Huerta S - J Med Case Rep (2010)

Gross pathologic specimen (A), and microscopic view demonstrating characteristic cribriform pattern abutting splenic capsule (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908633&req=5

Figure 2: Gross pathologic specimen (A), and microscopic view demonstrating characteristic cribriform pattern abutting splenic capsule (B).
Mentions: During follow up a computed tomography (CT) scan of the chest demonstrated bilateral lung nodules, which were consistent with metastatic disease (Figure 1B). However, there were no symptoms attributable to these lesions. The CT scan also demonstrated a lesion in the spleen that measured 4cm and was approximately 1mm from the splenic capsule (Figure 1A). He was referred to the surgical service when a follow up CT scan of the abdomen three months later demonstrated progression in size of the lesion by 1cm and our patient complained of left upper quadrant abdominal discomfort. There was no evidence of other intra-abdominal disease. Due to the progression in size of the splenic lesion, its proximity to the capsule with potential complications of rupture or local advancement, and in light of our patient's symptoms the decision was made to proceed with laparoscopic splenectomy. He was given appropriate pre-operative immunization. At the time of surgery, there was no evidence of other intra-abdominal disease. The spleen (Figure 2A) was removed intact through an enlarged port site incision. Pathologic examination (Figure 2B) showed a 5.2 × 4.3 × 4cm single metastatic nodule within 0.1cm from the capsule. The mass shows mucoid areas in the center and microscopically had features characteristic of adenoid cystic carcinoma with a predominant cribriform growth pattern. He had a routine convalescence, and is currently alive and well.

Bottom Line: A review of the literature did not yield any other such incidents.He initially developed asynchronous pulmonary metastases, which were resected.A splenectomy effectively addresses symptoms and serves as a cytoreduction modality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dallas VA Medical Center, Surgical Services (112), 4500 S Lancaster Road, Dallas, TX 75216, USA. brycew.murray@va.gov.

ABSTRACT

Introduction: Adenoid cystic carcinoma (ACC) of the larynx is a rare malignancy characterized by an indolent course and late pulmonary metastases. Metastases from the larynx to the spleen are an unusual event. In the present report, we discuss a patient with adenoid cystic carcinoma of the larynx metastatic to the spleen. A review of the literature did not yield any other such incidents. We review the clinical presentation and course of adenoid cystic carcinoma, as well as the role of splenectomy for metastases.

Case presentation: We present a case of laryngeal adenoid cystic carcinoma in a 26-year-old Caucasian man treated with total laryngectomy and ionizing radiation. He initially developed asynchronous pulmonary metastases, which were resected. Our patient subsequently presented with a symptomatic splenic lesion consistent with metastatic disease, for which he underwent laparoscopic splenectomy.

Conclusions: Splenectomy might be indicated for isolated metastases. A splenectomy effectively addresses symptoms and serves as a cytoreduction modality.

No MeSH data available.


Related in: MedlinePlus