Isolated splenic metastasis: An unusual presentation of colonic adenocarcinoma

It is very uncommon situation in which primary colonic carcinoma is asymptomatic and presents as isolated splenic metastasis. Involvement of spleen by secondary tumors is usually seen in disseminated spread of tumor. However, isolated splenic involvement by tumor metastasis is an infrequent event, except in cases of lymphoid origin malignancy where spleen is commonly involved. We hereby report a case of 50 years old man who presented with gradually increasing pain abdomen for 3 months. USG report showed splenomegaly indicating either splenic abscess or hemangioma. Splenectomy was performed followed by pathological examination. Histopathological examination (HPE) revealed diffuse infiltration of spleen by sheets and nests of malignant cells, suggesting metastatic adenocarcinoma to spleen. Subsequently computed tomography was done to find out the site of primary tumor. Thus a cystic mass in left splenic flexure of colon was identified on CT scan. Biopsy was done that suggested colonic cancer. Hence a diagnosis of colonic mucinous adenocarcinoma with metastatic splenic involvement was made. Patient was operated for the same and managed accordingly. Based on this case, we concluded that surgeons should pay careful attention to splenic lesions as metastatic deposits can be there, especially in old aged patients having features that favor some ongoing malignant disease.