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Case Reports
. 2018 Dec 18;11(1):e223453.
doi: 10.1136/bcr-2017-223453.

Splenectomy for breast carcinoma diffusely metastatic to the spleen presenting as severe transfusion-dependent anaemia and thrombocytopaenia

Rabea Hasadia  1 , Olga Kazarin  2 , Orit Sofer  3 , Katerina Shulman  2 , Anton Troitsa  1 , Ricardo Alfici  1 , Itamar Ashkenazi  4
Affiliations
Case Reports

Splenectomy for breast carcinoma diffusely metastatic to the spleen presenting as severe transfusion-dependent anaemia and thrombocytopaenia

Rabea Hasadia et al. BMJ Case Rep. .

Abstract

We report a 48-year-old woman with metastatic infiltrating lobular carcinoma of the breast. Though her metastatic disease remained stable, she was repeatedly admitted for symptomatic anaemia and treated by red blood cell and platelet transfusions with increasing frequency as time elapsed. Abdominal examination and ultrasound revealed splenomegaly (27 cm span). A bone marrow biopsy showed fibrosis and foci of metastatic carcinoma. Splenectomy ameliorated her transfusion-dependent anaemia and thrombocytopaenia. Histopathology revealed multiple foci of metastatic carcinoma and scattered foci of extramedullary haematopoiesis. Differential diagnosis of anaemia and thrombocytopaenia in patients with cancer include bone morrow involvement by cancer cells, iron-deficiency anaemia, microangiopathies and chemotherapy suppression of haematopoiesis. Splenic involvement with cancer is common in patients with multivisceral disease. Many may regard transfusion-dependent severe anaemia and thrombocytopaenia as an end-stage disease in these patients. Nevertheless, palliative splenectomy should be considered in patients with possible hypersplenism who will otherwise survive for a relatively prolonged period of time.

Keywords: breast cancer; palliative care; surgical oncology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Haemoglobin (Hb) and platelet (PLT) levels.
Figure 2
Figure 2
Red blood cell (RBC) transfusion needs.
Figure 3
Figure 3
Platelet (PLT) transfusion needs.
See this image and copyright information in PMC

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