Metastasis of nasopharyngeal carcinoma to the spleen: a case report.

BACKGROUND

Splenic metastasis from nasopharyngeal carcinoma (NPC) is exceptionally rare, accounting for only about 1% of all splenic metastases from solid tumors. Fewer than 30 cases have been documented worldwide. NPC is a common head and neck malignancy in certain regions, with a tendency to metastasize to regional lymph nodes in approximately 70% of cases, while distant metastases occur in about 30%. The spleen is an unusual site for secondary involvement, possibly due to its anatomical and immunological characteristics.

CASE DESCRIPTION: We report a 40-year-old male with a significant smoking history who initially presented with cervical lymphadenopathy and was diagnosed with Epstein-Barr virus-associated, poorly differentiated non-keratinizing NPC (T3N2M0). He received concurrent chemoradiotherapy, followed by several lines of systemic therapy and targeted radiotherapy for progressive bone and abdominal lymph node metastases. During follow-up, he developed intermittent left-sided abdominal discomfort. Positron emission tomography/computed tomography (PET/CT) and abdominal magnetic resonance imaging (MRI) demonstrated a new splenic lesion. Multidisciplinary tumor board review recommended laparoscopic splenectomy with distal pancreatectomy for both diagnostic and therapeutic purposes. The postoperative course was uneventful, and histopathology confirmed metastatic NPC. Despite surgery, subsequent surveillance revealed gastric metastasis, and the patient was placed on palliative systemic treatment.

CONCLUSIONS

Although rare, splenic metastasis should be considered in NPC patients presenting with new abdominal symptoms or suspicious imaging findings during surveillance. Early detection through advanced imaging modalities such as PET/CT, MRI, and ultrasonography can facilitate timely intervention. Splenectomy remains a reasonable option in selected cases, offering diagnostic certainty, symptom relief, and prevention of potential complications such as splenic rupture or local invasion.