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Splenectomy for breast carcinoma diffusely metastatic to the spleen presenting as severe transfusion-dependent anaemia and thrombocytopaenia
  1. Rabea Hasadia1,
  2. Olga Kazarin2,
  3. Orit Sofer3,
  4. Katerina Shulman2,
  5. Anton Troitsa1,
  6. Ricardo Alfici1 and
  7. Itamar Ashkenazi4
  1. 1 General Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel
  2. 2 Medical Oncology Unit, Hillel Yaffe Medical Center, Hadera, Israel
  3. 3 Hematology Unit, Hillel Yaffe Medical Center, Hadera, Israel
  4. 4 Surgical Oncology Service, Hillel Yaffe Medical Center, Hadera, Israel
  1. Correspondence to Dr Itamar Ashkenazi, i_ashkenazi{at}


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.

  • breast cancer
  • palliative care
  • surgical oncology

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  • Contributors All seven authors listed contributed significantly to this manuscript as described by the ICMJE Recommendations from 2013 as detailed below: Acquisition,analysis or interpretation of data: All authors (RH, OK, OS, KS, AT, RA and IA). Drafting of the manuscript: RH and IA, critical revision of the manuscript for important intellectual content: all authors (RH, OK, OS, KS, AT, RA and IA). Final approval: all authors (RH, OK, OS, KS, AT, RA and IA).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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