Splenectomy Reduced Transfusion Needs in Metastatic Lobular Breast Cancer

What happened, in summary

A 48-year-old woman was diagnosed with metastatic infiltrating lobular breast cancer after itchy skin lesions were initially found to contain adenocarcinoma. Breast imaging and biopsies identified the primary cancer. The tumor was estrogen- and progesterone-receptor positive and HER2 negative. Disease involved the skin, lymph nodes, bone, bone marrow, and later the spleen.

She began hormone therapy. When the cancer progressed, she received paclitaxel, then doxorubicin, followed by vincristine. Letrozole was later restarted. Although the metastatic disease became stable for a period, severe anemia and thrombocytopenia worsened. Her hemoglobin fell as low as 3 g/dL and platelets were often below 10,000 per microliter, requiring increasingly frequent transfusions.

Her spleen enlarged to 27 cm. She underwent removal of the spleen and an accessory spleen after other local options were discussed. Pathology confirmed extensive lobular breast-cancer metastases. Transfusion needs fell sharply after surgery: she received 193 red-cell units during the 13 months before surgery and 16 afterward. She remained independent at her final oncology visit 18 months after the operation and died 1 month later.