title: Pancreatic neuroendocrine tumor with metastasis to the spleen: a case report.
abstract: Long-term term survival in patients with pancreatic neuroendocrine tumors has been reported, even in patients with metastatic disease. Metastases to the spleen are extremely rare, but have been reported from a number of primary malignancies, such as breast cancer, lung cancer, melanoma and ovarian cancer. This is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor.
  
  
  
  The patient presented as a 53 years old white male with anemia and fatigue. Physical examination revealed a left upper quadrant fullness and computed tomography showed a 24 cm left upper quadrant mass with multiple liver metastases, splenomegaly and a 1 cm mass in the spleen. Resection of the primary pancreatic tumor (T4N0M1) was accompanied by gastrectomy, splenectomy and resection of adherent bowel. The spleen contained a metastatic lesion 1.0 cm in diameter, consistent with a primary neuroendocrine tumor of the pancreas. This operation was followed 8 months later, by delayed resection of liver metastases. The patient receives monthly administration of somatostatin long-acting analogue and has undergone several ablations of liver lesions with percutaneous radiofrequency ablation as well as a second liver resection. The patient is alive seven years after initial presentation, with no evidence of disease on imaging studies.
  
  
  
  This is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor. The patient initially presented with synchronous multiple liver metastases and a single splenic metastasis. After resection of the primary tumor and spleen, the patient has undergone aggressive cytoreductive surgery/ablation of liver lesions and somatostatin therapy with resulting long-term survival.
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hosoya
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Oncology, Jichi Medical University, Tochigi, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Pathology, Jichi Medical University, Tochigi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsubara
authors.affiliation: Department of Pathology, Jichi Medical University, Tochigi, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Fukushima
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miki
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Maeno
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan. alefor@jichi.ac.jp.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D013160:Splenic Neoplasms / Q000556:secondary* / Q000601:surgery
keywords: Case report; Liver metastasis; Pancreatic neuroendocrine tumor; Radiofrequency ablation; Somatostatin; Spleen metastasis