Breast Carcinoma Diffusely Metastatic to the Spleen: A Report of Two Cases Presenting as Idiopathic Thrombocytopenic Purpura

Abstract

Carcinoma metastatic to the spleen is found at autopsy in 6% to 13% of patients who die of cancer, yet clinical symptoms referable to splenic metastases are unusual. Two cases of breast carcinoma metastatic to the spleen discovered incidentally at therapeutic splenectomy for idiopathic thrombocytopenic purpura are described. On gross examination, the spleens were mildly enlarged with a homogeneous congested cut surface; rare 0.2-cm white nodules were present in one case. Microscopic examination revealed large, poorly cohesive cells that diffusely involved both the red and white pulp. Histochemical, immunohistochemical, and ultrastructural analyses confirmed the epithelial nature of the cellular infiltrate. These cases show that idiopathic thrombocytopenic purpura may herald the presence of diffuse splenic metastases when metastatic disease is not otherwise clinically suspected. The lack of a discrete tumor mass in the spleen in such cases may make the diagnosis of metastatic carcinoma a challenge both clinically and pathologically. Immunohistochemical and electron microscopic examinations are useful to establish the appropriate diagnosis in such cases.

Successful treatment of idiopathic thrombocytopenic purpura‐like syndrome in a cancer patient with low‐dose interferon: Case report and review of the literature

“…The results seemed similar to ITP-like cancer patients, where high-dose Cs (50-80 mg/day) proved effective in 1-3 weeks time in 17 of 24 (70%) treated patients, completely in 12, and partially in five [1,2,4,[9][10][11][12][13][14][15][16]. However, thrombocytopenia relapsed in eight (60%) of 14 of patients on tapering Cs dose [11,12,14].…”

“…This was found to be completely effective in nine (69%) cases [1][2][3]11,[13][14][15][16]. Splenectomy was not performed in our patient because of his disseminated disease.…”

“…Clinical information on this thrombocytopenic condition is scarce and is mainly derived from case reports [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] referring to adults with carcinomas of the breast, gastrointestinal tract, lung, ovary, testis, prostate, urinary bladder, kidney, skin, and vagina.…”

Thrombotic Thrombocytopenic Purpura Secondary to an Occult Adenocarcinoma

“…However, these and other investigations (gastroscopy, mammography, and bronchoscopy) could not document any primary neoplastic lesion. A diagnosis of TTP secondary to occult adenocarcinoma diffusely metastatic to bone marrow was established, but a few days later the patient died.Only a few cases of TTP secondary to metastatic adenocarcinoma are known in the literature [2][3][4][5][6][7]. The mechanism of secondary TTP is different from the idiopathic mechanism.…”

“…Only a few cases of TTP secondary to metastatic adenocarcinoma are known in the literature [2][3][4][5][6][7]. The mechanism of secondary TTP is different from the idiopathic mechanism.…”