脾脏转移癌的临床病理特点

Clinicopathologic characteristics of metastatic carcinomas to spleen

目的探讨脾脏转移癌的临床病理特点及其转移规律。方法总结16例脾脏转移癌病例,复习临床、外检、尸检记录资料,对其性别、年龄、临床症状、原发部位、组织学类型、脾脏的大体特点、脾脏内肿瘤的生长方式进行了分析。结果16例脾脏转移癌中,男性12例,女性4例;男性显著多于女性;年龄范围从48岁到90岁,其中位年龄为66·5岁;临床症状主要表现为左上腹不适,疼痛,消瘦乏力,食欲不振等,有些病例可扪及脾肿大,CT可发现脾内占位。肺是脾脏转移癌的最主要的原发部位,占总例数的43·8%(7/16);男性最常见的原发部位是肺,占50·0%(6/12),而女性最多见的是卵巢(2/4)。组织学类型中,肺未分化癌是最多见的类型,占25·0%(4/16),其中小细胞未分化癌3例,大细胞未分化癌1例;其他依次为:肺细支气管肺泡癌2例;结肠腺癌2例;卵巢浆液性乳头状囊腺癌2例;前列腺腺癌2例。男性最多见的类型是肺未分化癌,而女性为卵巢浆液性乳头状囊腺癌。脾脏转移癌的生长方式分为单结节性、弥漫性和多结节性3种类型,多数肿瘤表现为单结节性的生长方式,少数高转移潜能的肿瘤(5/16)表现为弥漫性和多结节的生长方式,包括肺小细胞未分化癌(3/3),肺腺癌(1/1)和前列腺腺癌(1/2)。结论脾脏转移癌少见,掌握其临床病理形态特点对于病理诊断和临床处理有指导意义。

Objective To study the clinicopathologic characteristics of metastatic carcinomas to the spleen. Methods Sixteen cases of metastatic carcinoma to the spleen were retrieved from archival clinical, surgical pathology and autopsy records. The demographic data （ including sex and age of patients）, clinical symptoms, primary sites, tumor histologic types, gross appearance of spleen and growth patterns within the spleen were analyzed. Results Among the 16 patients studied, 12 were males and 4 were females. The male predilection was obvious. The age ranged from 48 to 90 years, the median age 66. 5 years. Major clinical symptoms included discomfort in the left upper quadrant, pain, emaciation and loss of appetite. Splenomegaly was noted in some patients and computerized tomography could show space-occupying lesions in the spleen. In general, lung was the most common primary site for splenic metastasis and accounted for 43.8% of all cases （7/16）. In male patients, primary lung tumor was found in 50. 0% cases （6/12）. On the other hand, primary ovarian tumor was commonly seen in females （2/4）. Histologically, undifferentiated carcinoma of lung was frequently encountered （25.0% , 4/16）, including 3 cases of small cell undifferentiated carcinoma and 1 case of large cell undifferentiated carcinoma. Other histologic tumor types included bronchioloalveolar carcinoma （2 cases）, colonic adenocarcinoma （2 cases）, ovarian serous papillary adenocarcinoma （2 cases）, and prostatic adenocarcinoma （2 cases）. The commonest histologic tumor type found in male patients was pulmonary undifferentiated carcinoma. The growth patterns of metastatic carcinoma in spleen included nodular, diffuse and multinodular. Most cases presented as a single splenic nodule. Sometimes, tumors with high metastatic potential （5/16） showed diffuse and multinodular growth patterns. Examples of these tumors included small cell undifferentiated carcinoma （3 cases）, pulmonary adenocarcinoma （1 case） and prostatic adenocareinoma （1 case）. Conclusions Metastatic carcinoma to the spleen is rare. Understanding of the clinicopathologic characteristics is helpful in guiding clinical management and pathologic diagnosis.