Spleen Endoscopy: A sui generis Diagnosis of Colon Cancer

The initial analytical profile revealed anemia with a hemoglobin level of 8.7 g/dL and elevation of inflammatory parameters (white cell count of 18.6 × 10 9 /L and C-reactive protein of 20.0 mg/ dL). Blood and urine cultures, infectious disease serology, serum protein electrophoresis and prostate-specific antigen were negative. Abdominal ultrasound performed in the urgency setting was normal. Given the persistence of complaints and the inconclusive laboratory study, an abdominal computed tomography (CT) scan was performed. In the spleen, there was a hypodense, 6.3-cm lesion with a central liquid component and peripheral contrast enhancement suggesting an abscess. This lesion was continuous with the colon splenic angle whose wall was thickened suggesting an expansive neoplasm ( Fig. 1 ). It also revealed multiple infracentimetric pulmonary nodules that could be related to metastases. Colonoscopy was performed and at the splenic flexure, it revealed an exophytic, irregular and stenotic lesion followed by a dark-colored cavity corresponding to the interior of a splenic abscess allowing the direct visualization of the spleen ( Fig. 2 , 3 ). The biopsies taken on the colonic border of the lesion corresponded to an adenocarcinoma. The multidisciplinary team (encompassing oncologists and surgeons) opted for surgery; thus, the patient was admitted for left hemicolectomy with splenectomy. The histopathological analysis of the surgical specimen revealed a low-grade adenocarcinoma of the splenic flexure of the colon (G2), with infiltration of all the wall layers and in continuity with the spleen (pTMN T4b N1b). Patient recovery was ordinary and he started adjuvant chemotherapy.