METASTATIC CARCINOMA IN SPLEEN
This patient was investigated five weeks prior to his final admission for dysphagia, epigastric pain and weight loss. Carcinoma of the cardia was discovered and an oesophagogastrostomy performed. Post-operative recovery was uneventful and the patient was discharged. One week following his discharge he was re-admitted paraplegic, with a recurrence of his dysphagia. When examined the patient had urinary retention, paraplegia and a sensory loss to the level of approximately T.10. The paraplegia was thought to be due to spinal cord compression, this in turn to vertebral collapse due to metastases. Conservative care was instituted but the patient died five days later.
The specimen consists of a crescent-shaped slice of spleen 11 cm in length. Occupying approximately 75% of splenic substance are multiple deposits of yellowish, tumour tissue ranging from 1 to 20mm in maximum diameter. Beneath the capsule adjacent to these deposits is an irregular area of yellowish-grey tissue which represents an infarct. A small sectioned vessel at the hilum contains ante-mortem thrombus. This is an example of direct splenic invasion by carcinoma of the stomach via the hilum. At necropsy deposits were found in lymph glands, liver, vertebrae, skull and kidney.