Metastatic tumor of the spleen
Introduction
Introduction to spleen metastatic tumor A splenic metastatic tumor refers to a malignant tumor originating from the epithelial system and does not include malignant tumors originating from the hematopoietic system. Most of the spleen metastatic tumors are cancer metastasis, and Harmann et al. believe that direct invasion of tumors should not be included in metastatic spleen tumors, but most people prefer the former, because the metastasis pathway of malignant tumors is generally considered to be the above three aspects. The metastasis pathway of spleen metastasis is mainly lymphatic retrograde pathway, but for patients with extensive hematogenous metastasis, spleen can be used as one of the metastatic organs. Metastatic cancerous lesions often show most nodules or single nodules, and can also be characterized by most tiny nodules and diffuse infiltration. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: hypersplenism, hemolytic anemia, spleen rupture
Cause
Spleen metastatic tumor etiology
(1) Causes of the disease
The primary tumor of metastatic spleen tumor can be various organs of the whole body. The lung cancer, breast cancer, ovarian cancer, prostate cancer, colon cancer, stomach cancer, kidney cancer, cervical cancer, chorionic epithelial cancer and malignant melanin are disseminated from the blood. Tumors are more common, lymphatic pathways are common in abdominal organs, often accompanied by abdominal aorta or splenomegaly. Generally, tumor spleen metastasis can be used as part of systemic metastasis. In a few cases, it can be used as breast cancer, ovarian cancer, etc. The only secondary metastatic organ of the primary lesion.
(two) pathogenesis
Spleen metastatic tumors can occur in the sinus of the spleen, red pulp, white pulp and trabecular vessels. Microscopic examination is nodular or diffuse, the size is different, the boundary is clear, and large nodules can be accompanied by liquefaction necrosis. In the region, extensive spleen metastatic tumors can lead to an increase in the spleen, but the spleen contour can still be preserved.
Prevention
Spleen metastatic tumor prevention
1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.
Complication
Spleen metastatic tumor complications Complications spleen hyperfunction hemolytic anemia spleen rupture
A small number of patients may be associated with secondary hypersplenism, hemolytic anemia, pleural effusion, and a small number of cases of hemorrhagic shock due to spontaneous spleen rupture.
Symptom
Spleen metastatic tumor symptoms Common symptoms Abdominal pain fever Left upper abdomen pain Ascites low fever Upper abdominal discomfort Loss of appetite Lack of weight loss
Usually, when spleen metastasis occurs in cancer patients, there is a wide range of organ metastasis. Spleen metastasis usually does not cause splenomegaly, and the spleen only increases slightly, so it is completely normal. Therefore, there are often no special symptoms in clinical practice. Only when the spleen is significantly enlarged, it can produce a left upper abdominal mass, abdominal pain and symptoms of compression of surrounding organs, as well as fever, loss of appetite, weight loss, anemia, ascites and other signs.
Examine
Spleen metastatic tumor examination
1.CT and MRI performance
Spleen metastatic tumor CT showed normal size or mild to moderate enlargement of spleen, low density in spleen, clear or unclear footprint, and its size and number were different. CT value was 25Hu on average. Can be cystic changes, a small number of metastases are of equal density, can not be found in the flat scan, and enhanced after the performance of the lesions slightly lower than the normal spleen parenchyma, has been reported in the celiac artery slowly injected contrast agent in the portal vein CT scan, showing the presence or absence of metastasis in the liver or spleen, the display rate is higher than the direct increase in the vein, can find lesions with a diameter of 5 ~ 10mm, patients with metastatic tumors of the spleen are mostly accompanied by liver metastasis, so during the examination Should also pay attention to liver changes.
Spleen metastatic tumors showed irregular low signal area on T1-weighted images, which were single and multiple, with clear edges and increased signal intensity on T2-weighted images. Some of them showed central high signal due to increased central necrosis water content. On T2-weighted images, high signal can be seen in the peritumoral area due to edema around the tumor, while edema and necrotic areas on the T1-weighted image can show lower signal areas in low signals, such as bleeding in metastatic tumors. With a high signal, the spleen rarely metastasizes alone, often involving both the liver and lymph nodes.
2. Imaging methods and comparison
Ultrasound method is simple, but the experience of machine equipment and operators can affect the display of lesions. Generally, lesions with a diameter of 10mm or more can be found. Whether the lesions are substantive or cystic is sensitive, and ultrasound can also check other organs in the abdomen. Whether or not involved, such as adrenal gland, kidney, pelvic cavity, etc., radionuclide can only show the lesions larger than 20mm in diameter, and the morphology is poor, qualitative is difficult, MRI on the spleen within the lesions is determined by the spleen and lesions The signal intensity, and whether it is diffuse, if there is liquefaction necrosis in the lesion, the water increases, T2 prolongs, produces high signal on T2-weighted images, and sometimes difficult to find on T1-weighted images, the application of paramagnetic contrast agent T1 can be shortened to make the lesion easy to display. The choice of imaging method is ultrasound, CT, MRI and radionuclide. The combination of the above methods can make up for each other and improve the detection rate.
Diagnosis
Diagnosis and differentiation of spleen metastatic tumor
diagnosis
Most patients with spleen metastases have a history of cancer, often accompanied by late manifestations of weight loss, fatigue, hypothermia, anemia and other malignant tumors. A small number of patients may have discomfort or pain in the left upper abdomen. Physical examination may reveal spleen enlargement, history, symptoms and Signs, laboratory and imaging examinations are of great value in the diagnosis of spleen metastatic tumors.
Differential diagnosis
Multiple metastases of the spleen should be differentiated from lymphoma. Most of the former have a history of tumor, while the latter has persistent high fever, systemic lymphadenopathy, abnormal bone marrow and blood, and benign to the spleen for cystic metastases in the spleen. Identification of cysts, the wall of cystic metastases tends to thicken, and there may be formation of nodular nodules. The "bull eye" sign or "target heart" sign is typical, while the spleen benign cyst wall is thin and smooth, and the CT value is water sample. Density, a single metastatic nodule in the spleen must be differentiated from hemangioma, hamartoma and other benign lesions, only morphologically difficult to distinguish, but if the patient has a previous history of the tumor, the metastasis should be considered, short-term follow-up observation is also benefit.
