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Special Feature
January 2011January 17, 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(1):116. doi:10.1001/archsurg.2010.296-b
Answer: Colon Cancer With Splenic Abscess

The final pathological examination results showed T4N0 poorly differentiated adenocarcinoma with direct invasion of the spleen.

Splenic abscess is a rare presentation of colon cancer.1,2 There are fewer than 10 reported cases in the English literature. Splenic abscess can occur because of direct invasion or local perforation into the spleen,1,2 synchronous splenic metastasis with abscess,3 or hematogenous spread to the spleen.4

Colon cancer with direct invasion to surrounding tissue or organ is classified as T4 according to the American Joint Committee on Cancer's TNM staging system,5 and curative treatment involves en bloc resection of the tumor and the involved tissue or organ. Additional adjuvant chemoradiotherapy might be indicated depending on the nodal status.

Hematogenous spread to a distant site can occur during transient bacteremia from necrotic tumors and can subsequently present as splenic abscess.4Streptococcus bovis septicemia can be associated with gastrointestinal lesions, especially with colorectal cancer. Presentation is frequently delayed, and clinical manifestations include fever, left upper-quadrant pain, and leukocytosis. Administration of intravenous antibiotics and splenectomy constitute the definitive therapy for splenic abscess due to hematogenous spread because percutaneous drainage has a failure rate of 50% to 60%.6 However, percutaneous drainage is an option for patients who cannot tolerate splenectomy.

Article

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Article Information

Correspondence: Michael P. Vezeridis, MD, Department of Surgery, Rhode Island Hospital/Warren Alpert Medical School of Brown University, 2 Dudley St, Ste 470, Providence, RI 02905 (Michael_Vezeridis@brown.edu).

Accepted for Publication: September 14, 2009.

Author Contributions:Study concept and design: Tan, Griffith, and Vezeridis. Acquisition of data: Tan. Analysis and interpretation of data: Tan. Drafting of the manuscript: Tan. Critical revision of the manuscript for important intellectual content: Griffith and Vezeridis. Administrative, technical, and material support: Tan. Study supervision: Griffith and Vezeridis.

Financial Disclosure: None reported.

Submissions

The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.

References
1.
Kawamoto  KTeramoto  TWatanabe  M  et al.  Splenic abscess associated with colon cancer: a case report. Jpn J Clin Oncol 1993;23 (6) 384- 388
PubMed
2.
Shinhar  SNobel  MRosso  YShimonov  MEntebi  E Splenic abscess as a presenting sign of colonic carcinoma. Dig Surg 1997;14 (5) 426- 428doi:10.1159/000172588
3.
Pisanu  ARavarino  ANieddu  RUccheddu  A Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: a case report and review of the literature. World J Gastroenterol 2007;13 (41) 5516- 5520
PubMed
4.
Belinkie  SANarayanan  NCRussell  JCBecker  DR Splenic abscess associated with Streptococcus bovis septicemia and neoplastic lesions of the colon. Dis Colon Rectum 1983;26 (12) 823- 824
PubMed
5.
American Joint Committee on Cancer Colon and rectum.  In: Edge  SB, Byrd  DR, Compton  CC, Fritz  AG, Greene  FL, Trotti  A, eds. AJCC Cancer Staging Manual.7th ed. New York, NY: Springer-Verlag; 2010:143-164
6.
McIntyre  TZenilman  ME Cysts, tumors, and abscess of the spleen.  In: Cameron  JL, ed. Current Surgical Therapy.9th ed. Philadelphia, PA: Mosby Elsevier; 2008:551-553
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