A report of laryngeal adenocystic carcinoma metastatic to the spleen and the role of splenectomy in the management of metastatic disease: a case report

Abstract

Introduction: Adenoid cystic carcinoma (ACC) of the larynx is a rare malignancy characterized by an indolent course and late pulmonary metastases. Metastases from the larynx to the spleen are an unusual event. In the present report, we discuss a patient with adenoid cystic carcinoma of the larynx metastatic to the spleen. A review of the literature did not yield any other such incidents. We review the clinical presentation and course of adenoid cystic carcinoma, as well as the role of splenectomy for metastases.

Case presentation: We present a case of laryngeal adenoid cystic carcinoma in a 26-year-old Caucasian man treated with total laryngectomy and ionizing radiation. He initially developed asynchronous pulmonary metastases, which were resected. Our patient subsequently presented with a symptomatic splenic lesion consistent with metastatic disease, for which he underwent laparoscopic splenectomy.

Conclusions: Splenectomy might be indicated for isolated metastases. A splenectomy effectively addresses symptoms and serves as a cytoreduction modality.

Figure 1

Computed tomography revealed splenic lesion (A, identified with arrow) and demonstrating metastatic lung lesions (B, identified with arrows).

Figure 2

Gross pathologic specimen (A), and microscopic view demonstrating characteristic cribriform pattern abutting splenic capsule (B).

Figure 3

Chart showing the source of splenic metastases from a large autopsy review[12].

Figure 4

Chart demonstrating source of solitary splenic metastasis[13].