Isolated splenic metastasis from lung squamous cell carcinoma

Isolated splenic metastasis from lung cancer is an exceedingly rare event. Here, we present the case of an 82-year-old male with previously excised lung squamous cell carcinoma who developed local recurrence and a splenic metastasis. This is only the 17th known report of isolated splenic metastasis, including English and non-English literature.In April 2006, an 82-year-old former smoker male was investigated due to persistent cough. A Computed Tomographic (CT) scan of the chest showed a 2.2 × 1.5 cm nodule in the right mid-lung. Bronchoscopic biopsies revealed a moderately differentiated Squamous cell carcinoma (Figure 1). Preoperative investigation showed no mediastinal lymphadenopathy or distant metastatic disease.The patient underwent a right bilobectomy confirming a moderately differentiated squamous cell carcinoma with large polygonal cells, keratinization, intercellular bridges and keratin pearls (pT2pN2). As margins were scanty, adjuvant chemo-radiation was indicated (4 cycles of Carboplatin and Paclitaxel and 50 Gy). Patient remained asymptomatic and sixteen months after surgery a CT scan revealed a 1 × 1 cm cystic lesion in the spleen (Figure 2). Follow-up was lost and a new CT scan was only performed one year later. This exam revealed an interlobular thickening and an enlargement of the splenic lesion now measuring 6.5 × 6.4 cm (Figure 2). The patient was then referred to palliative chemotherapy with Gemcitabine and received 4 cycles (3 of them with reduced dose due to mielotoxicity). A new CT scan showed stability of the pulmonary disease but progress of the splenic lesion (7.8 × 7.8 cm - Figure 2). Splenectomy was then indicated. During preoperative period the patient presented an acute bowel obstruction. A CT scan of the abdomen and pelvis showed an abrupt obstrutive point at the level of the left colon and the patient underwent an urgent laparotomy. Surgical findings consisted of the large splenic lesion without invasion of adjacent structures and a le