Surgery for an isolated splenic metastasis from lung adenocarcinoma

What happened, in summary

A 73-year-old woman was found to have a new splenic cyst during routine CT surveillance. Twenty-eight months earlier, she had undergone right lower lobectomy for a pT1aN0 primary lung adenocarcinoma. She had not received neoadjuvant or adjuvant chemotherapy or radiation and was asymptomatic when the splenic lesion appeared.

PET imaging showed activity in the splenic cyst, and image-guided aspiration confirmed adenocarcinoma matching the lung primary. No other metastatic site was identified. After multidisciplinary review, she proceeded with surgery for the isolated recurrence in early 2019. The splenic lesion was tethered to the diaphragm, so the spleen and affected portion of the diaphragm were removed together, followed by primary diaphragmatic repair.

Her postoperative course was complicated. On the third day, she needed more oxygen. CT excluded pulmonary embolism but showed pleural effusions, left-sided compressive atelectasis with consolidation, and a large fluid collection in the splenic bed. She received antimicrobial treatment for hospital-acquired pneumonia and underwent image-guided placement of pleural and splenic-bed drains. By postoperative day 10, imaging showed complete resolution of both collections. She continued ward-based rehabilitation and was discharged home.

At nine months, surgical follow-up found no evidence of local or disseminated recurrence. She continued regular surveillance for lung cancer. Her case reflects a rare delayed metastatic pattern in which an apparently early lung adenocarcinoma returned as a solitary splenic lesion that could be treated surgically.