Detection of Muscular Metastasis in a Case of Parathyroid Carcinoma Using 18 F-FAPI-04 PET/CT.

ABSTRACT: A 46-year-old woman underwent surgery for parathyroid carcinoma 2 years ago. During follow-up, the patient presented with elevated parathyroid hormone (127.50 pg/mL; normal, 15-65). No abnormal uptake of 18 F-FDG or 11 C-choline was observed on 18 F-FDG and 11 C-choline PET/CT imaging. The patient was enrolled in a clinical trial for 18 F-FAPI PET/CT imaging, revealing a lesion with intense focal uptake within the left sternocleidomastoid muscle. The patient underwent surgery. Postoperative pathology and immunohistochemical analysis confirmed parathyroid carcinoma metastasis.

The Uncharted Territories of Esophageal Cancer with Cardiac and Skeletal Muscle Metastasis: A Case Report and Literature Review.

Background: Esophageal cancer (EC) comprises 1% of all diagnosed cancers in the USA. It is more common in other parts of the world. If there is distant metastasis, the relative survival rate is 6%. There are no standardized screening methods for EC. Case Presentation: We reported a four-year case of esophageal cancer, a P53-positive mutation with atypical distant metastasis to the cardiac and skeletal muscles. The patient was managed with multimodal therapy, including immunotherapy, which could have been a factor in prolonged survival. Conclusions: Distant metastases are typically seen postmortem, and with prolonged survival, we are able to find such unique metastases antemortem. Despite a history of negative scans, the patient's ctDNA (circulating tumor DNA) remained positive, which was a better predictor of recurrence in this case. Future research is required to establish cost-effective screening methods and standardized treatments.

Management of intramuscular melanoma metastases to the psoas.

We detail a case of a woman in her 40s with isolated melanoma skeletal muscle metastasis (MSMM) to the right psoas muscle. This patient underwent R0 surgical resection through a novel pelvic approach. She received subsequent adjuvant immunotherapy with Braftovi/Mektov along with adjuvant radiation. She is currently disease free at 9 months post surgery. Here, we describe our novel surgical approach including description of the tumour pathology. We explain our multidisciplinary management of MSMM consisting of a multidisciplinary surgical approach by surgical oncology, gynecological oncology and urology as well as multidisciplinary medical management by oncology, radiation oncology and pathology. Finally, we discuss best current options for therapeutic management.

Cardiac and Intramuscular Metastases Following Nephroureterectomy for Metachronous Urothelial Carcinoma.

BACKGROUND We present a case of metachronous cardiac and intramuscular metastases in a patient with a known history of radical nephroureterectomy for upper-tract urothelial carcinoma (UTUC). CASE REPORT A 58-year-old man had a history of metachronous renal pelvis urothelial carcinoma with prior left radical nephroureterectomy. He was also diagnosed with malignancy-associated deep vein thrombosis (DVT) and was on rivaroxaban. He presented at an oncology follow-up consult with shortness of breath and right scapular lump. CT scan revealed a soft-tissue mass at the surgical bed suspicious for local recurrence, as well as intracardiac hypodensities and intramuscular nodules in the right latissimus dorsi and right adductor muscles. The intracardiac hypodensities were located in the left atrial appendage and inter-atrial septum. Given that the patient had a history of DVT and in a pro-thrombotic state, differentials for the intracardiac densities included intracardiac thrombi or metastases. The intramuscular hypodensities were rim-enhancing. Given that the patient was on rivaroxaban, differentials included hematomas or metastases. As there was no overlying bruising and the lesions remained unchanged in size clinically, they were treated as metastases. The patient was treated with clexane but re-presented with worsening of shortness of breath and palpitations. CT scan showed increased size of intracardiac lesions, suggesting no response to anticoagulation, and therefore were likely metastatic in nature. He completed a 2-year course of IV pembrolizumab and was in complete remission. CONCLUSIONS Our case highlights the importance of this clinically challenging scenario when patients with known malignancy and on anticoagulation present with cardiac or musculoskeletal symptoms. Though these patients are at risk of thrombus and haematoma, cardiac and intramuscular metastasis should be considered, as the prognosis is guarded.

Recurrent Metastatic Ewing Sarcoma Involving Only in the Muscles of Extremities Shown on FDG PET/CT.

ABSTRACT: Ewing sarcoma is the second most common osseous malignancy in pediatric patient. Metastasis is common due to its aggressive nature, with 25% of patients with metastasis at diagnosis, commonly to the lungs, bone, or bone marrow. Muscle metastasis is uncommon. We report FDG PET/CT findings of multifocal muscle metastases of recurrent Ewing sarcoma in the extremities without lung and bone involvement in a 6-year-old boy.

Multispecialty Management of Metastatic Colon Adenocarcinoma Involving the Extraocular Muscles: Primary Excision and Simultaneous Treatment of Strabismus With a Review of the Literature.

Metastatic colon adenocarcinoma involving the extraocular muscles is extremely rare. It usually develops following the diagnosis of the systemic disease and therefore, management and treatment require a multispecialty approach. Within this manuscript, we provide a summary of cases of orbital metastasis secondary to colon cancer. We further discuss a detailed case of a 42-year-old male patient who developed recent-onset diplopia in the left gaze. Orbital CT imaging showed a localized, well-circumscribed enlargement of the right medial rectus muscle. The biopsy of the right medial rectus showed adenocarcinoma originating from the gastrointestinal system. Further workup revealed colon adenocarcinoma with multiple metastatic sites. The patient started systemic chemotherapy. After 2 months of chemotherapy (5-fluouracil, oxaliplatin, irinotecan, and leucovorin), all systemic metastatic sites regressed; however, his medial rectus muscle continued to grow, causing compressive optic neuropathy. The patient underwent excisional biopsy of the right medial rectus muscle with simultaneous repair of the strabismus with transposition of superior and inferior recti muscles. He continued with systemic chemotherapy. Follow up in 1 year revealed no local orbital tumor recurrence with excellent visual acuity and no diplopia in primary gaze.

LMNA::NTRK1 Fusion-positive Leiomyosarcoma: Discrepancy between DNA-based Comprehensive Genomic Profiling and RNA Sequencing.

A 26-year-old man presented with a tumor in the left soleus muscle. The tumor was diagnosed as a locally advanced leiomyosarcoma. The patient was treated with irradiation followed by wide resection. One year after surgery, the patient presented with multiple lung metastases. Despite aggressive sequential chemotherapy, systemic metastatic tumors continued to develop. To explore therapeutic options for the patient, we performed DNA-based CGP with FoundationOne® CDx (F1). F1 identified an out-of-strand rearrangement of the NOS1AP::NTRK1 gene, which has not been previously reported. In contrast, RNA sequencing revealed an in-frame LMNA::NTRK1 gene, which is an oncogenic fusion gene.

Thigh mass in a patient with malignant pleural mesothelioma: Metastasis at an unusual site.

Soft tissue tumors are a highly heterogeneous group of lesions with varied clinical presentation. The majority is primary tumors and metastatic tumors are very rare. Malignant pleural mesothelioma presenting as a soft tissue mass at a distant site is even rarer and can cause diagnostic challenges both clinically and pathologically. We report a case of malignant pleural mesothelioma presenting as a soft tissue mass in the left thigh. A 59-year-old man, non-smoker, working in a cement factory since 30 years presented with complains of difficulty in walking since 1½ months. Review of his previous medical records revealed malignant pleural mesothelioma, which was diagnosed 9 months before. He had denied chemotherapy and was on Ayurvedic medication. The lesion involved the adjacent intercostal muscles. Few enlarged lymph nodes were noted in mediastinal and cervical regions. Biopsy of left supraclavicular and right cervical lymph nodes showed metastases. Metastasis from malignant pleural mesothelioma to the thigh was confirmed by immunohistochemistry. The tumor was positive for CK5/6, CK7, Calretinin and vimentin and immunonegative for CEA, Napsin A and TTF 1.

Skeletal muscle metastasis from a gastrointestinal stromal tumor: A case report.

RATIONALE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Common sites for metastasis are the liver and peritoneum, whereas skeletal muscle metastases are rare. PATIENT CONCERNS: A 59-year-old man with skeletal muscle metastasis was diagnosed during a period of adjuvant imatinib therapy following the recurrence of GIST of the small intestine. DIAGNOSIS: The patient was diagnosed with skeletal muscle metastasis of GIST based on immunohistochemistry and molecular pathology analysis results. INTERVENTION: Extensive resection of the left thigh tumor was performed. The patient underwent whole-exome sequencing of tissue examination. The results suggest that resistance to imatinib may have been developed, and the patient was therefore administered sunitinib instead. OUTCOMES: Complete remission was observed following sunitinib therapy. LESSONS: In cases of skeletal muscle metastasis diagnosed during a period of adjuvant imatinib therapy following the recurrence of a GIST of the small intestine, whole exome sequencing may be used to discover more gene variations.

A Muscle-Invasive Bladder Cancer Patient With High Tumor Mutational Burden and RB1 Mutation Achieved Bladder Preservation Following Chemotherapy Combined With Immunotherapy: A Case Report.

Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for patients diagnosed with muscle-invasive bladder cancer (MIBC). However, urinary diversion following radical cystectomy significantly reduces patient quality of life. In addition, patients who significantly respond to neoadjuvant chemotherapy have a strong will to preserve the bladder. Bladder-sparing therapy has become a research focus worldwide. Although the bladder-sparing regimen, referred to as trimodality therapy (TMT), has been accepted, the efficacy of immunotherapy combined with chemotherapy for bladder preservation in patients with MIBC has not yet been published. We describe the case of a 50-year-old male presented intermittent macrohematuria and was diagnosed with bladder urothelial carcinoma by diagnostic transurethral resection of bladder tumor (TURBt) with clinical stage IIIA (cT3bN0M0). A complete response was achieved after four courses of neoadjuvant chemotherapy combined with pembrolizumab. Then, we performed a second TURBt plus randomized biopsy by cystoscopy. The pathology indicated no tumor in the bladder. Adjuvant chemoradiotherapy and immunotherapy were subsequently performed. Imaging examinations, cystoscopy and urine tumor DNA (utDNA) levels were used for surveillance after treatment. Finally, the patient achieved bladder preservation and had remained cancer-free for 19 months at the last follow-up on February 20, 2021. This is the first published case study to describe neoadjuvant chemotherapy plus pembrolizumab followed by concurrent chemoradiotherapy as a novel bladder-sparing regimen and successfully achieved a promising outcome.

Systemic dissemination of tumor cells during transurethral resection in patients with bladder tumor and its clinical relevance: A follow up study.

OBJECTIVE: Tumor cells are shed during transurethral resection of bladder tumor (TURBT) and form the basis for use of single dose immediate chemotherapy instillation to reduce recurrences. Systemic dissemination of these cells along with the irrigation fluid is also possible but not consistently proven. In this study, we evaluated such dissemination of tumor cells into the circulation during TURBT and its clinical impact. METHODS: Patients with primary presentation of bladder tumor who underwent TURBT were included. Peripheral venous blood samples before and after TURBT were analyzed for circulating tumor cells (CTCs) using flow-cytometry. A CD45 negative cell with positive expression of cytokeratin 18, 19, and EpCam was defined as CTC. The CTC counts, pre and post TURBT, were compared and correlated with final histopathology. The patients were also followed up for any local and/or systemic recurrences. RESULTS: Nine (16.98%) out of 53 patients developed a measurable rise in CTCs after TURBT. All of these patients had high grade and muscle invasive disease. Overall, a measurable rise in CTCs was seen in 9 out of 17 (52.94%) patients with muscle invasive disease. There was no difference in the clinico-pathological stage or the status of cystectomy and/or chemotherapy between those who did or did not show a rise in CTCs. On follow up, 7 patients with muscle invasive disease developed local and/or systemic recurrences and the rise in CTCs was not found to be associated with adverse oncological outcomes. CONCLUSIONS: This study confirms the hypothesis of inadvertent dissemination of tumor cells into the circulation during TURBT, especially in patients with high grade and muscle invasive disease. The long-term oncological impact of such dissemination remains to be confirmed.

Gastric adenocarcinoma presenting with multiple skeletal muscle metastases.

A 42-year-old man presented to the gastroenterology clinic with features of gastric outlet obstruction, significant weight loss, anaemia, ascites, and pain in the lower back and left thigh. CT scan of the abdomen and pelvis showed wall thickening in the antropyloric region of the stomach and enhancing soft tissue lesion in the left psoas and right gluteal region. Gastroscopy revealed a circumferential growth in the antrum and pylorus of the stomach, and biopsy from the growth was reported as moderately differentiated adenocarcinoma. Positron emission tomography-CT scan showed multiple skeletal muscle metastases all over the body. Fine-needle aspiration cytology and immunohistochemistry from the psoas lesion confirmed metastatic adenocarcinoma deposits. He underwent antropyloric stenting for his obstructive symptoms and received supportive care, finally succumbed to his illness after 6 weeks.

Ovarian adenocarcinoma with metastases in a white rhinoceros.

A 36-y-old white rhinoceros (Ceratotherium simum) was presented with respiratory distress, sanguineous vaginal exudate, and anorexia. The clinical signs progressed over 40 d, and the rhinoceros died. Autopsy revealed significant ascites; a unilateral, 12.5-cm diameter, polypoid mass in the left ovary; a white, firm transmural mass in the right uterine horn; a white, friable mass in the lung; and white-to-tan, friable small nodules in the diaphragm. Histologic examination revealed similar neoplastic cells in the masses in all 4 locations, composed predominantly of epithelial cells proliferating in a tubulopapillary pattern with significant nuclear atypia and numerous atypical mitotic figures (18-42 per 2.37 mm2). Immunohistochemistry for CK7 (cytokeratin 7) and CK20 (cytokeratin 20) suggest that the ovarian, pulmonary, and diaphragmatic lesions were of ovarian origin and that the ovary was the primary tumor site.

Surgical excision of a malignant metastatic melanoma located in a skeletal muscle of the lateral thorax of a horse.

BACKGROUND: A 20-year-old grey Warmblood gelding that had history of dermal melanomatosis. OBJECTIVE: To report surgical treatment of a 6-cm large malignant metastatic melanoma located in the cutaneous trunci muscle of the left lateral thorax of a horse. METHODS: A 20-year-old grey Warmblood gelding was referred for evaluation of a large, rapidly growing, thoracic mass. Clinical examination revealed an ovoid, firm, non-painful, movable mass, approximately 6 cm in diameter, located in the cutaneous trunci muscle of the left lateral thorax. Multiple melanocytic nodules were also found at the perianal region and ventral tail. Rectal examination, ultrasonography and endoscopy of the respiratory tract revealed no melanomas internally. Haematological and biochemical values were within normal limits. Surgical excision of both the thoracic mass and perianal nodules was the treatment of choice. Histopathology of the distant thoracic mass confirmed the diagnosis of malignant metastatic melanoma secondary to the perineal lesions that were confirmed as dermal melanomatosis. RESULTS: The horse recovered uneventfully. Up until 3 years post surgery there was no tumour regrowth at the excision sites. CONCLUSION: Surgical excision of the metastatic melanoma was performed and considered successful, with no gross evidence of tumour reoccurrence. Despite the fact that surgical excision is considered a treatment option regarding equine dermal melanomatosis, there is no previously published study proposing surgical removal of distant malignant metastatic melanocytic masses. This is the first report of a successful surgical excision of a large (6 cm) metastatic melanocytic tumour from the skeletal muscle of the lateral thorax of a horse.

Clinical questions on rehabilitation in cancer patients with skeletal metastasis: a content analysis of the multidisciplinary tumor board records.

PURPOSE: Cancer rehabilitation addresses the functional needs of patients who have various impairments. Disease control is a critical oncological consideration, while physical intervention increased weights of importance in several situations. To identify the clinical status that necessitates active physical intervention in cancer patients with skeletal metastasis, we performed a content analysis in the multidisciplinary tumor board (MDTB) records. METHODS: From January 2017 to September 2019, the MDTB discussed 168 consecutive patients with skeletal metastasis. We reviewed the MDTB records and asked responsible physicians to frame clinical questions. Based on these data, we identified the predictor valuables with the association to rehabilitation-related clinical questions using univariate and multivariate analyses. Moreover, we investigated a predictor of the change in Barthel index (BI) scores using univariate analyses. RESULTS: Rehabilitation-related questions arose more frequently in older patients (p = 0.011), in patients with slow-growth vs. rapid-growth tumor (p = 0.002), and in patients with skeletal-related events (p = 0.001) at MDTB. The tumor growth speed was associated with the change in BI scores, as slower-growth tumors had the benefit of BI gains (p = 0.017). CONCLUSIONS: Regarding rehabilitation in patients with skeletal metastasis, we should pay attention to three parameters: occurrence of skeletal events, patient age, and growth speed of tumors. Rehabilitation-related questions may reflect patients' functional needs that occur more frequently in patients with pathological fractures or neurological symptoms, older patients, and patients with slow-growth tumors.

Metástasis muscular. Presentación de un carcinoma renal / Muscle metastasis as presentation of kidney cancer / Metástase muscular. Relato de caso de carcinoma renal

Resumen: Introducción: el cáncer de riñón frecuentemente se presenta con metástasis sincrónicas. Son excepcionales los casos comunicados en la literatura donde el diagnóstico de la enfermedad surge a partir de una metástasis muscular. Objetivo: el objetivo del trabajo es presentar un caso clínico de metástasis en músculo deltoides izquierdo como primera manifestación de un carcinoma de células claras de riñón. Caso clínico: paciente de 76 años, sexo masculino, que se operó con diagnóstico de tumoración de región delitoidea izquierda cuyo estudio anatomopatológico informó una metástasis muscular de un carcinoma renal de células claras. Se realizó una tomografía axial computarizada que evidenció una tumoración renal derecha, por lo cual se realizó una nefrectomía que confirmó el diagnóstico del tumor primario. Discusión: el diagnóstico de metástasis muscular de un carcinoma de células claras de riñón, cuando es la primera manifestación de la enfermedad, habitualmente se realiza con el estudio de la pieza de resección quirúrgica o bien a través de una biopsia. Si bien el tratamiento de la metástasis en general es paliativo, el control local de la enfermedad solo es posible cuando se realiza una resección quirúrgica con márgenes libres, ya que otros tratamientos oncológicos no han demostrado ser eficaces.

Summary: Introduction: most kidney cancer patients present with synchronous metastatic disease. A review of the literature reveals cases where the diagnosis is based on muscle metastasis are exceptional. Objective: the study aims to present the clinical case of metastasis to the left deltoid muscle as the initial presentation of renal cell carcinoma. Clinical case: 76 year old male patient who was operated upon diagnosis of tumour in the left deltoid region, the biopsy of which revealed muscle metastasis of clear cell renal cell carcinoma (RCC). Computerized axial tomography evidenced a tumorous formation in the right kidney. The patient underwent right-sided nephrectomy that confirmed the primary tumour diagnosis. Discussion: diagnosis of muscle metastasis of clear cell renal cell carcinoma, being it the initial presentation of the disease, is often done by analysing the surgical resection piece or by means of a biopsy. Despite treatment of metastasis is usually palliative, local control of the disease is only possible when tumour-free margins surgical resection is done, since other oncologic treatments have not proved effective.

Resumo: Introdução: o câncer renal frequentemente se apresenta com metástases sincrônicas. São excepcionais os casos relatados na literatura em que o diagnóstico da doença decorre de uma metástase muscular. Objetivo: o objetivo do trabalho é apresentar um caso clínico de metástase no músculo deltóide esquerdo como primeira manifestação de um carcinoma de células claras do rim. Caso clínico: paciente do sexo masculino, 76 anos, submetido à cirurgia com diagnóstico de tumor na região do deltóide esquerdo, cujo estudo anatomopatológico relatou metástase muscular de carcinoma renal de células claras. Foi realizada tomografia axial computadorizada que revelou tumor renal direito, sendo realizada nefrectomia que confirmou o diagnóstico do tumor primário. Discussão: o diagnóstico da metástase muscular do carcinoma de células claras do rim, quando é a primeira manifestação da doença, geralmente é feito com o estudo da peça de ressecção cirúrgica ou por meio de biópsia. Embora o tratamento das metástases em geral seja paliativo, o controle local da doença só é possível quando a ressecção cirúrgica é realizada com margens livres de patologia, uma vez que outros tratamentos oncológicos não têm se mostrado eficazes.