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+A 59-year-old man was referred to the general surgery department of our hospital for a one-month history of progressive dysphagia for solids, which was not associated with malnutrition or significant weight loss.
+The patient had recently undergone esophagogastroduodenoscopy in another hospital, which revealed a bleeding, ulcerative lesion in the middle third of the esophagus, but no biopsy had been collected.
+The medical past history included COPD diagnosed in 1999 and a myocardial infarction in 2002.
+The patient had smoked approximately 25 cigarettes per day for several years.
+Physical examination was unremarkable.
+Computed tomography (CT) of the chest and abdomen revealed stenosis involving a 5-cm segment of the middle third of the esophagus with no other lesions in the thoracic or abdominal organs.
+Barium studies disclosed a swelling in the esophageal wall 7 cm above the cardia with an ulcerative pattern, which reduced the diameter of the lumen to 5 mm.
+An endoscopic biopsy of the oesophageal mass demonstrated poorly differentiated (G3) squamous cell carcinoma.
+Mid-distal esophagectomy was performed with oesophagogastric anastomosis and gastric tube reconstruction.
+Pathological examination of the surgical specimen confirmed the biopsy diagnosis of poorly differentiated (G3) SCC.
+The tumor, which measured 3 cm of length, had infiltrated the oesophageal wall and the surrounding paraesophageal fat.
+Surgical margins were tumor-free, as the seven perigastric limph-nodes dissected (pT3 N0).
+The postoperative period was quite unremarkable, and a contrast enhanced x-ray obtained on the 9th POD showed normal esophageal and gastric transit.
+On the 14th POD, the patient was discharged with an oncology referral for routine medical follow-up.
+Nine months after the operation, CT and esophagogastroduodenoscopy were repeated.
+The imaging study revealed mild splenomegaly with multiple nonspecific nodules within the organ (Figure ​1).
+The patient was virtually asymptomatic with the exception of a vague sensation of mild discomfort in the left upper quadrant of the abdomen.
+FNAC of the spleen revealed a pattern of numerous inflammatory cells admixed with large cells displaying immunohistochemical positivity for several cytokeratins (Figure 2).
+The specimen was Gram stain-negative.
+A bone-marrow biopsy was negative for metastatic involvement.
+The diagnosis was isolated metastases of the spleen with inflammatory and necrotic alterations.
+The patient was referred to our centre for splenectomy, which was performed as a routine procedure to role out, also, a spontaneous rupture of the spleen.
+On 12th December 2007, the patient had transabdominal total splenectomy with splenic and celiac artery lymph node dissection.
+The postoperative course was uneventful.
+On the 7th postoperative day, Doppler ultrasonography revealed portal-tree patency with no signs of thrombosis.
+Ten days later, the patient was discharged with a stable platelet count (780,000/mm3), Hb 10.9 g/dL, and a WBC count of 16,500/mm3.
+Pathological examination of the spleen described multiple nodules containing medium to large-sized cells, some of which were keratinized.
+The nodules were mostly solid with areas of central necrosis (Figure ​3).
+The findings were consistent with metastases of SCC.
+Thereafter, the patient was referred to the oncology department of our hospital, where he received two 3-day cycles (separated by a 3-week interval) of systemic chemotherapy based on 5-fluorouracil (800 mg/day IV) and cisplatin (20 mg/day).
+Three months after the splenectomy, multiple liver metastases were seen on the CT scan, and cutaneous metastases were also present.
+The patient died 9 months later.