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. 2020 Jul 29;6(1):185.
doi: 10.1186/s40792-020-00955-1.

Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review

Haruhiko Okada  1 , Kazutomo Ouchi  2 , Tetsuya Saito  2 , Yuka Takahashi  2 , Masaki Yamada  2 , Naoki Negami  2 , Yasunori Ishido  2 , Sanae Yamazaki  3 , Masahiko Sato  2
Affiliations

Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review

Haruhiko Okada et al. Surg Case Rep. .

Abstract

Background: The occurrence of sarcoid reactions has been recognized in various cancers. The common location for observing these granulomas is mainly the lymph nodes, but a rare occurrence in the spleen has been reported. Almost all splenic sarcoid reactions associated with gastric cancer have been resected synchronously and diagnosed accidentally, and a rare metachronous occurrence of a sarcoid reaction in the spleen after distal gastrectomy can mimic cancer metastasis. We describe a rare case of a splenic sarcoid reaction recognized in a patient with gastric cancer 6 months after distal gastrectomy.

Case presentation: An 82-year-old man underwent laparoscopic distal gastrectomy for gastric cancer (T3N0M0, stage IIA). Six months after gastrectomy, CT and 18F-fluorodeoxyglucose (FDG)-PET/CT showed the appearance of a splenic mass. We diagnosed solitary splenic metastasis from gastric cancer and performed laparoscopic-assisted splenectomy. His splenic tumor was diagnosed as a sarcoid reaction by histopathological examination.

Conclusion: To our knowledge, this is the first report of a splenic sarcoid reaction recognized 6 months after distal gastrectomy for gastric cancer without any chemotherapy. The splenic sarcoid reaction and cancer metastasis to the spleen were undistinguishable from the CT and FDG-PET/CT findings. The present case and literature review showed that cases of splenic sarcoid reactions associated with gastric cancer can also be accompanied by the occurrence of these granulomas in lymph nodes. When the appearance of a solitary mass is observed in the spleen after resection of primary cancer, it is necessary to consider not only cancer metastasis but also sarcoid reactions. Retrospective histopathological confirmation of the existence of sarcoid reactions in lymph nodes from resected specimens might possibly avoid incorrect diagnosis and intervention.

Keywords: Gastric cancer; Sarcoid reaction; Spleen; Splenectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Endoscopy showing type 2 tumor measuring 50 mm at the anterior wall of the lower third of the stomach
Fig. 2
Fig. 2
a The CT scan 6 months after gastrectomy shows the appearance of a low-density lesion that is 17 mm in diameter at the spleen. b Preoperative CT scan shows no lesion at the spleen recognized
Fig. 3
Fig. 3
a The PET/CT shows intense fluorine-18 fluorodeoxyglucose (18F-FDG) uptake with a maximum standardized uptake value (SUV) of 5.82 (arrowhead) at the spleen. b Retrospectively, preoperative PET/CT shows very faint uptake (maximum SUV, 4.76) at the spleen
Fig. 4
Fig. 4
Intraoperative image showing the dissected line (broken line) just at the point of the splenic hilum, and the short gastric vessels in the gastrosplenic ligament were preserved as much as possible to supply the remnant stomach. S, spleen
Fig. 5
Fig. 5
3D-CT angiography to evaluate the formation of the vessels at the hilum of the spleen
Fig. 6
Fig. 6
a Operative specimen showing two splenic tumors measuring 20 mm (arrow) and 7 mm (arrowhead). b Histopathological findings of the spleen showing epithelioid cell granulomas without caseous necrosis and no evidence of malignant cells. c The retrospective histopathological findings of the regional lymph nodes show noncaseous epithelioid granulomas (sarcoid reaction)
See this image and copyright information in PMC

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