British Journal of Urology (1998), 82, 597–598

CASE RE PORT

Splenic metastasis from adenocarcinoma of the prostateM.S. NASEEM, H.A. JAN*, K.E. BRITTON* and V.H. NARGUNDDepartments of *Nuclear Medicine and Urology, St Bartholomew’s Hospital, London, UK

from a primary adenocarcinoma of the prostate. MostCase reportsplenic metastases are haematogenous. Presentation ismost often incidental in the surveillance of patients whoA 76-year-old man with an 18-month history of aden-

ocarcinoma of the prostate, treated with maximumandrogen blockade, presented with symptoms of BOO.Ultrasonography of the urinary tract showed normalfindings and a 2 cm focal, echogenic mass within thespleen, suggesting a metastatic lesion. A subsequent CTscan (Fig. 1) showed low-density lesions within thespleen, raising the possibility of metastatic lesions.Radioimmunoscintigraphy using 111In-labelled mono-clonal antibody CYT-356 (anti-prostatic membrane-specific antigen [ProstascintTM]) confirmed the presenceof prostatic adenocarcinoma in the spleen (Fig. 2) andin the prostate bed, by single-photon emission tomogra-phy (Fig. 3). Currently, the patient remains asympto-matic with a PSA of 0.5 mg/L.

Comment

Splenic secondaries rank 10th among the 44 metastaticsites described in the literature. In two large autopsyseries, an incidence of 3.1–7% was reported for this site[1]. The commonest primary is melanoma, with tumoursof the bronchus, pancreas, breast, stomach (cardia) andovary comprising >60% of the primary tumours. Thus,the present case is the first reported of splenic metastasis

Fig. 2. Radioimmunoscintigraphy of the liver and spleen with111In-CYT-356 (Prostascint). Planar images showing a posteriorview of the liver and spleen taken 24 h after injection. The spleenshows two focal areas of increased uptake in yellow on the brown-red background. In the liver there are two focal red areas with awhite surround. A colour scale is shown at the top. The focalareas indicate two metastases of prostate cancer to the spleen andtwo to the liver on this view. The high liver background is causedby non-specific uptake of the monoclonal antibody, with deposition

Fig. 1. CT scan showing splenic secondaries. L, Liver. S, Spleen. of 111Indium. L, liver. S, spleen.

597© 1998 British Journal of Urology

598 CASE REPORTS

Fig. 3. Single-photon emission tomogramsof the pelvis 24 h after injection withProstacint, sectioned at the level of theprostate; upper row (I) transverse frominferior to superior; middle row (II) coronalfrom back to front; and lower row (III)sagittal from right to left. Focally increaseduptake is clearly seen in the prostatic bed, inred (red cross). In the transverse section, theexternal and internal iliac vessels are shownin section. On the coronal section, the aorticbifurcation is seen superiorly, on the sagittalsection genital activity is seen inferiorly andanteriorly.

prostate with the monoclonal radioimmuno conjugatehave undergone surgery, and is rarely clinical with pain,technetium-99m-7E11-C 5.3 (CYT- 351). J Nucl Med 1997;splenomegaly and splenic rupture. It is usually based on38: 675–81medical imaging, including ultrasonography, CT and

3 Bahian RJ, Sayer J, PodoloC DA et al. Radio-MRI. In the absence of haemostatic disorders, percu-immunoscintigraphy of pelvic lymph nodes with Indium-taneous needle biopsy is possible but carries the risks of111 labelled monoclonal antibody, CYT 351. J Urol 1994;

an invasive procedure. 99mTc- or 111In-labelled prostatic152: 1952–5

radioimmunoscintigraphy are alternative diagnostic,noninvasive techniques to confirm local recurrences and

Authorssecondaries from prostatic carcinoma [2,3]. Treatment,if at all indicated, is usually splenectomy, but should M.S. Naseem, BCh, FRCS, Registrar in Urology.

H.A. Jan, MBBS, MSc, Registrar in Nuclear Medicine.follow accepted oncological guidelines.K.E. Britton, MD, MSc, FRCR, FRCP, Professor of Nuclear

Medicine.References V.H. Nargund, PhD, FRCS(Urol), Consultant Urologist.

Correspondence: Mr M.S. Naseem, Department of Urology,1 Tiszlavicz L. Splenic metastases, a review. Orvosi Hetilap1996; 137: 295–8 King George V Building, St Bartholomew’s Hospital, West

Smithfield, London EC1 A7BE, UK.2 Chengazi W, Feneley MR, Ellison D et al. Imaging the

© 1998 British Journal of Urology 82, 597–598