Unusual vascular changes in the red pulp of the spleen accompanying breastcarcinoma metastasis

The prevalence of splenic metastasis from carcinomas varies between 2% and 13% in autopsy studies. Most of them are clinically inapparent. We report h erein the case of a splenic metastasis revealing breast carcinoma in a 73-y ear old woman. Splenectomy was performed to correct hypersplenism. Macrosco pically, the cut surface of the spleen was uniform and pale. On microscopic al examination, the metastatic infiltration involved both red and white pul p as single cells, cords and micro-nodules. Tumor cells were positive for c ytokeratin and epithelial membrane antigen (EMA). The breast origin of this splenic metastasis was supported by the increase of CA 15-3 level, and by the appearence of axillary lymphadenopathy. In addition, the red pulp sinus es were obliterated by multiple thrombi at different stages of development and the splenic cords were collagenized. These changes could result from an unusual stromal reaction.