Image of the Month—Diagnosis

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.

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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.

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