Malignant melanoma with liver and spleen metastases: case report

Rationale:An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors.Patient concerns:We report a case of a 60-year-old man who presented with multiple lung metastases and a solitary splenic metastasis with advanced stage melanoma following excision of primary from his trunk 2.3 years back.Diagnosis:Considering the diagnosis of advanced stage melanoma with multiple lung metastases and a solitary splenic metastasis, and its ongoing progressive nature. This case was discussed in the tumour board meeting.Interventions:A decision was made to commence treatment with immunotherapy in the form of PD-1 inhibitor (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer tomography (CT) scan of the abdomen and chest showed a significant reduction in the lung and chest wall lesions, but the splenic lesion remained unchanged. Given the lack of response to treatment in the splenic metastasis and the significant decrease in lung metastases, the multidisciplinary team decided that a partial splenectomy combined with continued immunotherapy treatment would be appropriate as the success of immunotherapy was imminent within the splenic preservation.Outcomes:The postoperative recovery was smooth and the patient was discharged from hospital on the sixth postoperative day with normal platelets and white blood cells. The histopathological analysis of the resected specimen showed a metastatic melanoma with negative margins.At 10-month follow-up after the splenic resection the patient had not experienced further tumour recurrences.Lessons:Spleen-preserving resection for an isolated, solitary splenic metastasis of melanoma is a feasible approach as it not only preserves the ongoing efficacy of checkpoint inhibitors by preserving the physiological T cell milieu, but the immunomodulation properties of RF can produce potentially additional therapeutic benefit.

show abstract

“…An incidental diagnosis of splenic metastasis has been made on imaging performed for other reasons or autopsy. [ 21 – 23 ]…”

Section: Discussionmentioning

confidence: 99%

Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors

Mudan

Jayant²,

Mafalda³

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…An incidental diagnosis of splenic metastasis has been made on imaging performed for other reasons or autopsy. [21][22][23] There are many case reports present in the literature which suggest splenectomy as a therapeutic option. However, due to the recent success and reported improved survival following the inception of immune checkpoint blockade drugs (anti-CTLA4, anti-PD-1, and anti-PD-L1) there is emerging evidence toward the role of splenic preservation.…”

Section: Discussionmentioning

confidence: 99%

Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors

2017

Medicine

View full text Add to dashboard Cite

Rationale: An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors.Patient concerns: We report a case of a 60-year-old man who presented with multiple lung metastases and a solitary splenic metastasis with advanced stage melanoma following excision of primary from his trunk 2.3 years back.Diagnosis: Considering the diagnosis of advanced stage melanoma with multiple lung metastases and a solitary splenic metastasis, and its ongoing progressive nature. This case was discussed in the tumour board meeting.Interventions: A decision was made to commence treatment with immunotherapy in the form of PD-1 inhibitor (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer tomography (CT) scan of the abdomen and chest showed a significant reduction in the lung and chest wall lesions, but the splenic lesion remained unchanged. Given the lack of response to treatment in the splenic metastasis and the significant decrease in lung metastases, the multidisciplinary team decided that a partial splenectomy combined with continued immunotherapy treatment would be appropriate as the success of immunotherapy was imminent within the splenic preservation.Outcomes: The postoperative recovery was smooth and the patient was discharged from hospital on the sixth postoperative day with normal platelets and white blood cells. The histopathological analysis of the resected specimen showed a metastatic melanoma with negative margins.At 10-month follow-up after the splenic resection the patient had not experienced further tumour recurrences.Lessons: Spleen-preserving resection for an isolated, solitary splenic metastasis of melanoma is a feasible approach as it not only preserves the ongoing efficacy of checkpoint inhibitors by preserving the physiological T cell milieu, but the immunomodulation properties of RF can produce potentially additional therapeutic benefit.Abbreviations: anti-CTLA4 = anticytotoxic T-lymphocyte-associated protein 4, anti-PD-1 = antiprogrammed cell death protein 1, anti-PD-L1 = antiprogrammed cell death-ligand 1, BRAF = B-Raf protein kinase, CT = computer tomography, MEK = mitogenactivated extracellular signal regulated kinase, PD-1 = programmed cell death 1 receptor, RF = radiofrequency.

show abstract

“…Metastatic and malignant lesions of the spleen are uncommon, and their incidence is less than 5%. 13,14 In the presence of hyperechoic or hypoechoic multiple or solitary splenic lesions with vascularity, LCA should be considered in the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%