【摘要】 目的　探讨脾转移癌 (MCS)的诊断及临床病理特征。　方法　报告 4例MCS的临床资料 ,结合文献进行临床病理分析。　结果　 4例MCS占 195 9～ 1999年间 30 8例脾活检病例的 1 3%。临床主要表现为左上腹疼痛和包块。癌灶位于脾上极 1例 ,脾下极 2例 ,脾下极 +脾门部 1例。肉眼观均为结节型。组织学类型 :来自胰腺腺泡细胞癌 2例 ,肝细胞癌和横结肠腺癌各 1例。临床诊断MCS 1例 ,3例被误诊。综合国内文献资料 ,MCS具有以下临床病理特征 :(1) 30～ 6 0岁的患者占6 6 7% ,平均年龄 5 1 2岁 ;(2 ) 76 3%有左上腹疼痛 ,6 3 2 %伴脾肿大或包块 ;(3)肉眼观 6 8 4%为结节型病变 ;(4 )腺癌占 84 2 %。 70 3%原发于结肠癌、肝细胞癌、卵巢癌和胰腺癌 ;(5 )B超和 (或 )CT示脾占位性病变或肿块者占 76 7% ,提示MCS者占 11 8% ;(6 )临床上被误诊者占 73 7%。　结论　MCS少见 ,临床误诊率高。影像学检查有助于临床诊断。临床医师和病理医师应相互协作 ,增强对MCS的诊断意识 ,以提高MCS的诊断水平和检出率更多还原

【Abstract】 Objective To study the clinicopathologic features and diagnosis of metastatic carcinoma to the spleen(MCS). Methods Four patients (1 man and 3 women, mean age 43.5 years) with MCS were analyzed clinicopathologically. Results The four MCS patients accounted for 1.3% of 308 patients having spleen biopsy from 1959 to 1999. Their chief presentations were pain and mass in the left upper quadrant of the abdomen. The mass was located in the upper pole of the spleen (1 patient), the lower pole of the spleen (2), or the lower pole and hilum of the spleen (1). Macroscopically, all of the lesions were nodular. Histologic type of these MCSs included acinar cell carcinoma of the pancreas (2 patients), transverse colon adenocarcinoma (1), and hepatic cell carcinoma(1). Clinically, 1 patient was diagnosed as having MCS and 3 were misdiagnosed. According to Chinese literature, the clinicopathologic features of MCS were as follows: (1) 66.7% of the patients with MCS were aged 30～60 years, with a mean of 51.2 years. (2) 76.3% of the patients presented with pain in the left upper quadrant of the abdomen and 63.2% with splenomegaly and splenic masses. (3) Macroscopically, nodular lesions accounted for 68.4%. (4) Microscopically, 84.2% of the lesions were adenocarcinomas and 70.3% originated from carcinomas of the colon, liver, ovary and pancreas. (5) B-mode ultrasonography and/or CT showed occupying lesions or masses in the spleen in 76.7%, and MCS in 11.8%. (6) Clinically, 73.7% of the patients were misdiagnosed. Conclusions MCS is uncommon but its clinical misdiagnosis rate is high. Image examination is of value in clinical diagnosis. Cooperation of clinicians and pathologists may enhance the diagnostic level of MCS.更多还原