Muscle metastasis from cervical chordoma: a case report.

Chordomas are rare primary bone tumours that commonly occur in the sacrococcygeal and skull base region and have high rates of local recurrence. They have a locally aggressive course and the most common site of distant metastasis is the lung. The aim of this case report is to present the imaging findings of instance of muscle metastasis, a rare occurrence in cervical chordoma.

Gastroesophageal Junction Adenocarcinoma With Skeletal Muscle Metastases: A Case Report and Literature Review.

Esophageal and gastroesophageal junction (GEJ) malignancies are aggressive, and survival is poor once metastasis occurs. The most common sites of metastatic involvement include the liver, lymph nodes, lung, peritoneum, adrenal glands, bone, and brain, while skeletal muscle (SM) involvement is rare. We report a case of a 68-year-old female who presented with intractable emesis for one month and was found to have a primary GEJ adenocarcinoma measuring up to 6.7 cm. Endoscopic biopsy revealed poorly differentiated GEJ adenocarcinoma with positive AE1/AE3 immunostains. Positron emission tomography/computed tomography and magnetic resonance imaging revealed metastases to the omentum and left lower extremity SMs, including the proximal adductor longus, adductor magnus, and gluteus minimus. This study reviews the literature on SM metastasis in esophageal and GEJ cancer, GEJ cancer classification, incidence, treatment, and prognosis.

Metastatic Bladder Urothelial Carcinoma Masquerading as Myositis.

Skeletal muscle metastases are uncommon, and metastases of urothelial carcinoma to the skeletal muscle are particularly rare. The most common presentation of skeletal muscle metastases is a focal mass, but their clinical and radiographic findings can be diverse. We present an unusual case of a 71-year-old male without prior known history of malignancy who presented with skeletal muscle pain with imaging most consistent with an inflammatory or infectious process but was ultimately determined to be metastatic urothelial carcinoma from the bladder. This case demonstrates the need to keep an expanded differential for muscular pain, particularly when initial treatments are ineffective.

Port-Site Metastasis After Laparoscopic Gastrectomy Extending to the Thigh: A Case Report.

Port-site metastasis (PSM) is rare following laparoscopic gastrectomy for gastric cancer. Previous reports focused on localized lesions treated with excision; contrastingly, case reports describing extensive invasion into the lower extremity skeletal muscles causing deterioration in activities of daily living are nonexistent. A 55-year-old male underwent a laparoscopic distal gastrectomy for gastric cancer. The pathological findings revealed a stage IIIA tumor. Two years later, skin hardening was observed on the left upper abdominal wall. Computed tomography displayed a 13-cm-long, flat tumor along the skeletal muscle around the left upper 12 mm port site and right hydronephrosis. The patient was diagnosed with PSM and retroperitoneal recurrence. Despite chemotherapy, three years postoperatively, PSM widely spread from the left upper abdomen to the left thigh, eventually inducing opioid-resistant leg pain and subsequent walking difficulties. Palliative radiotherapy could not improve these symptoms. The patient died three years and five months postoperatively. Extensively invasive PSM can induce refractory cancer pain and physical disorders. Therefore, early detection and palliative resection of PSM may help maintain the quality of life of patients with gastric cancer.

Upper Tract Urothelial Carcinoma Complicated by Skeletal Muscle Metastases.

Urothelial carcinoma typically metastasizes via a lymphatic route to sites such as lymph nodes, bone, and liver. As in other malignancies, metastasis to skeletal muscle is rare. We present a case of a 66-year-old male with severe muscular pain after diagnosis of upper tract urothelial carcinoma, who was found to have extensive metastasis to skeletal muscles including gluteal, sternocleidomastoid, deltoid, vastus lateralis, and gastrocnemius muscles. Literature review demonstrated 18 previously reported cases of urothelial cell carcinoma with skeletal muscle metastasis, all male and all with bladder involvement. This case emphasizes the importance of thoroughly evaluating all muscular pain in patients with a history of malignancy as it may represent skeletal muscle metastasis with an associated increase in morbidity and mortality.

Multiple Muscle Metastases as the First Presentation of Gastric Cancer: A Case Report and Review of Literature.

The presence of an abdominal wall mass may serve as the initial presentation of an unknown gastric malignancy. The invasion of the abdominal wall and the occurrence of multiple skeletal muscle metastases originating from gastric cancer are exceedingly uncommon. We present a case of a 45-year-old female patient exhibiting widespread abdominal wall infiltration and skeletal muscle metastases derived from gastric cancer. The primary presentation included a distressing diffuse abdominal mass in the left upper and lower quadrants. Abdominal computed tomography revealed extensive swelling of multiple skeletal muscles within the abdominal wall, raising suspicions of gastric malignancy. Biopsies of the affected muscles, along with upper gastrointestinal tract endoscopy and colonoscopy, were performed. The upper endoscopy examination unveiled a poorly differentiated diffuse-type gastric adenocarcinoma, while the subsequent muscle biopsy confirmed infiltration by the recently diagnosed malignancy. At this stage of the disease, systemic chemotherapy was deemed the optimal choice for our patient. Subsequent abdominal computed tomography showed a decrease in the dimensions of the abdominal wall and other skeletal muscle lesions. Seventeen months after the initial diagnosis, our patient continues to be alive. Additionally, we provide a comprehensive review of the existing literature on similar reported cases of gastric cancer patients with concurrent muscle metastases.

A Rare Case of Non-small Cell Lung Cancer With Skeletal Metastasis to the Sartorius Muscle.

We report an interesting case of skeletal muscle metastasis from lung cancer. Skeletal muscle metastasis is an unusual clinical occurrence and therefore lacks a standardized treatment approach. A 60-year-old female patient initially presented with abdominal pain and was found to have right lung consolidation, two hepatic lesions, and a lesion to the sartorius muscle. Initially treated as pneumonia, questions arose as to the lesion to the liver as well as the sartorius muscle. The primary site of malignancy was initially questioned due to the large size of the two hepatic lesions, with differential diagnoses including lung or hepatic origin. The sartorius muscle biopsy confirmed the presence of an adenocarcinoma lesion, consistent with non-small cell lung cancer (NSCLC).

Necrotizing Pneumonia, a Skeletal Muscle Lesion, and a Fungating Duodenal Mass: An Atypical Presentation of Rapidly Progressing Lung Adenocarcinoma.

Lung adenocarcinoma, the predominant subtype of non-small cell lung cancer, typically metastasizes to common sites such as the liver and adrenal glands. However, rare instances involve skeletal muscle metastasis. We present a case of a 45-year-old female with a medical history of hypertension, epilepsy, and fibromyalgia, who presented to the emergency department with hemoptysis and multifocal pain. Chest imaging revealed a cavitary lesion which appeared to be necrotizing pneumonia. Further investigations uncovered a fluid collection in the left thigh, which would be identified as poorly differentiated carcinoma. Subsequent testing identified the lung as the primary source of metastasis. Despite radiation treatment, the patient's condition deteriorated over the next 50 days, highlighting the aggressive nature of the disease.

Primary rectal adenocarcinoma with musculoskeletal metastasis as the only metastasis site: A case report with a short literature review.

Rectal carcinoma with metastasis to skeletal muscle is a rare occurrence. Since 1970, only 30 cases of skeletal muscle metastasis originating from colorectal adenocarcinomas have been documented, underscoring its exceptionally low incidence. Here, we present the case of a middle-aged man who was diagnosed with rectal adenocarcinoma 3 months ago. During examination, a subcutaneous mass was discovered in the left proximal buttock. Histological analysis of a biopsy confirmed that this mass was a metastatic lesion originating from the primary rectal adenocarcinoma.

Extensive Skeletal Muscle Metastases in Malignant Pleural Mesothelioma Detected by FDG PET/CT.

Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor originating from pleural mesothelial cells. Distant skeletal muscle metastasis is rare in MPM. A 54-year-old woman was diagnosed with epithelioid MPM and treated with surgery, chemotherapy, and radiotherapy 2 years ago. During follow-up, diffuse irregular pleural thickening with focal chest wall invasion in the right hemithorax and two small pleural thickenings in the left hemithorax were seen on control diagnostic contrast-enhanced computed tomography (CECT). Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) imaging was performed as part of restaging. PET showed diffusely increased FDG uptake in the recurrent right pleural tumor, and two hypermetabolic small metastatic foci in the contralateral pleura. In addition, multiple hypermetabolic areas of various sizes in various skeletal muscle localizations, suggestive of extensive muscle metastases were noted. Histopathologic study confirmed metastatic epithelioid MPM. FDG PET/CT revealed multiple muscle metastases which were not observed on earlier CECT and contributed to the visualization of more extensive metastatic involvements in the presented case with MPM. FDG PET/CT can detect rarely seen skeletal muscle metastases that are not visualized on diagnostic CT, and provides more accurate restaging of MPM.

Melanoma: Multiple Presentations of an Invisible Illness.

Melanoma can spread to any organ of the body. The most affected sites are the skin and subcutaneous tissue, lymph nodes, lungs, liver, brain, bone, and intestine. Early diagnosis is crucial to prompt treatment. Although the incidence of melanoma is rising, novel treatment options are being developed, enabling a better prognosis. The authors present a rare case of metastatic melanoma affecting the muscle, lymph nodes, and subcutaneous tissue. The patient complained of redness and swelling of the right thigh and inguinal region, red, painful lumps on her chest wall, and pain in the left upper abdominal quadrant. A CT of the thorax, abdomen, and pelvis was performed, and surgical excision of the left thoracic mass led to the diagnosis of metastatic melanoma. However, no primary lesion was found despite extensive investigation. The unusual presentation of muscular metastasis heralds a poor prognosis. This case highlights the difficulty of diagnosing patients with rare presentations of a rather frequent disease.

Multifocal Ectopic Recurrence of a C2 Chordoma.

Background Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection. Case Report We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site. Primary tumor resection was achieved via a combination of surgery, adjuvant radiation therapy, and imatinib. All recurrences were successfully resected and confirmed via pathology to be ectopic chordoma. Discussion Ectopic recurrence of cervical chordoma is rare and lung is the most common site of distant spread. Chordoma recurrence in skeletal muscle is particularly rare, with only 10 cases described in the literature. A plausible mechanism of distant metastatic disease in chordoma patients suggests that tumor cells escape the surgical tract via a combination of cytokine release, vasodilation, and microtrauma induced during resection. Conclusion Cervical chordoma with ectopic recurrence in skeletal muscle has not been previously described in the literature. Skull base surgeons should be aware of the phenomenon of chordoma ectopic recurrence in the absence of local recurrence.

Soft Tissue and Lower Limb Muscle Metastases from Breast Carcinoma: An Unreported Entity.

Soft tissue metastasis from carcinoma breast is rare, and still rarer is metastasis to skeletal muscles. So far, soft tissue metastasis from breast carcinoma has been reported only in a small number of case series and case reports. To the best of our knowledge, no case of breast cancer metastasizing to the lower limb muscles has been reported. It is important to differentiate soft tissue metastasis from primary soft tissue malignancy, as the management and prognosis of these differ markedly. Here, we present a case of breast cancer metastasizing to the soft tissue at multiple sites including the right thigh muscles.

A Rare Case of Abdominal Wall Skeletal Muscle Metastasis From Adenocarcinoma of the Pancreatic Head.

Pancreatic cancer can be aggressive and commonly metastasizes to various organs. Most commonly, pancreatic cancer metastasizes to the lung, liver, bones, and peritoneum, but very rarely does it spread to the abdominal wall or skeletal muscle. In this case, we discuss a patient who initially presented with weight loss and jaundice from a pancreatic head adenocarcinoma that later metastasized to the rectus abdominis muscle. A 63-year-old female presented with jaundice and weight loss. CT imaging revealed a 2.8 cm pancreatic head mass with pancreatic and biliary ductal dilation. Carbohydrate antigen 19-9 (CA 19-9) level was also found to be elevated to 1810 U/mL. An endoscopic ultrasound-guided biopsy was later performed and confirmed pancreatic adenocarcinoma. The patient underwent a Whipple pancreatoduodenectomy following initial treatment with neoadjuvant FOLFIRINOX chemotherapy. Following the Whipple procedure, she received adjuvant chemotherapy and subsequent imaging revealed no recurrence and decreased CA 19-9 level to 46 U/mL. Eight months afterward, the patient presented once again with lower abdominal pain. Repeat CA 19-9 level was found to have increased to 1503 U/mL. Repeat positron emission tomography scan imaging was performed and showed a 4.7 cm left rectus abdominis muscle mass. The mass was later biopsied, and pathology revealed recurrent, metastatic pancreatic adenocarcinoma. The patient was restarted on chemotherapy with paclitaxel and gemcitabine leading to a reduction in tumor size and CA 19-9 levels of 135 U/mL. However, surgical resection was later pursued due to increased tumor size only four months later. At this time, limited literature is available reporting the occurrence of pancreatic cancer metastasizing to the abdominal wall. Upon literature review, only five cases have been reported to date, and only two of the cases involved the skeletal muscle. Our rare case is the first-time documentation of rectus abdominis metastasis from pancreatic adenocarcinoma arising from the pancreatic head.

Melanoma of unknown primary origin with skeletal muscle metastasis: a case report.

BACKGROUND: Melanoma is usually discovered from an irregular skin patch or a modification of a preexisting patch. Cutaneous and lymph node metastases are common. Muscle metastases are rare. We report a case of melanoma with infiltration of the gluteus maximus, which had normal dermatological examination. CASE PRESENTATION: A 43-year-old Malagasy man with no history of skin surgery was admitted with progressively worsening dyspnea. On admission, he presented with superior vena cava syndrome, painless cervical lymphadenopathy, and a painful swelling in the right buttock. Skin and mucous membrane examination did not reveal any abnormal or suspicious lesions. The biology was limited to a C-reactive protein of 40 mg/L, a white blood cell count of 23 G/L, and a lactate dehydrogenase level of 1705 U/L. The computed tomography scan showed several lymphadenopathies, compression of the superior vena cava, and a tissue mass at the expense of the gluteus maximus. Cervical lymph node biopsy and cytopuncture of the gluteus maximus were consistent with a secondary melanoma location. A stage IV melanoma of unknown primary origin, and with stage TxN3M1c associated with lymph node metastases and extension to the right gluteus maximus, was suggested. CONCLUSIONS: Melanoma of unknown primary origin accounts for 3% of diagnosed melanomas. Diagnosis is difficult in the absence of a skin lesion. Patients are diagnosed with multiple metastases. Muscle involvement is unusual and may suggest a benign pathology. In this context, biopsy remains essential for diagnosis.

Case report: skeletal muscle metastasis from follicular thyroid carcinoma presenting as synovial sarcoma.

Differentiated thyroid carcinomas tend to remain localized and usually are of slow progression with excellent long-term survival. The major sites of distant metastases are cervical lymph nodes, lungs and bones and the minor sites include the brain, liver, pericardium, skin, kidney, pleura and muscle. Skeletal muscle metastases from differentiated thyroid carcinoma, are exceedingly rare. In this report, a 42-year-old woman with follicular thyroid cancer that had had a total thyroidectomy and radioiodine ablation nine years ago was presented with a painful right thigh mass and negative PET/CT scan. The patient had also lung metastases during the follow-up period which were treated with surgery, chemotherapy and radiation therapy. An MRI scan of the right thigh showed a deep-seated lobulated mass with cystic regions, bleeding elements and strong heterogeneous post contrast administration enhancement. Due to the similarities in clinical manifestations and imaging features between soft tissue tumors and skeletal muscle metastases, the case was initially misdiagnosed in favor of synovial sarcoma. Histopathological, immunohistochemistry and molecular analysis of the soft tissue mass confirmed to be a thyroid metastasis and, as a result, a final diagnosis of skeletal muscle metastasis was provided. Even though the probability of a skeletal muscle metastasis from thyroid cancer approaches zero, this study aims to raise the awareness to the medical community that these events do in fact occur in the clinical setting and should be considered in the differential diagnosis of patients with thyroid carcinomas.

Early and post-treatment imaging findings in perineural spread: a pathway to diffuse muscle metastasis in recurrent bladder carcinoma.

Perineural spread (PNS) from pelvic carcinoma has been regarded as a pathway to muscle and bone metastasis. However, few cases have been reported, especially in patients with bladder carcinoma. In the present report, we discuss a case of diffuse cancer involvement in the muscle 5 years after radical cystectomy for advanced bladder carcinoma. Careful observation of temporal changes on medical images confirmed PNS as the pathway to muscle metastasis (i.e., primary PNS). Our report presents early and post-treatment CT, MRI and FDG-PET/CT findings of PNS from the bladder carcinoma.

Skeletal muscle dissemination in a dog with T-cell lymphoma.

A 5-year-old spayed female American Staffordshire was referred for weakness, reluctance to move and distension of the abdomen. Three weeks before, the dog underwent surgery for excision of a nodular mass suspected to be a non-epitheliotropic cutaneous T-cell lymphoma (NE-CTCL). Computed tomography revealed heterogeneous enhancing mesenteric masses and nodular lesions of soft tissue density, and infiltration of the abdominal muscular wall. Moreover, a pattern of diffuse muscle nodules in the skeletal muscles was visible, with lesions showing homogenous, heterogeneous or ring enhancement. Necrosis was histologically observed and these lesions were infiltrated by CD3-positive and CD20-, CD79a- and Iba1-negative neoplastic lymphocytes. On the basis of the immunopathological features metastatic NE-CTCL was suspected. Skeletal muscle metastasis has been rarely reported in small animals and this case report further confirms that this possibility should be considered in dogs with lymphoma.

Pancreatic Cancer with a Skeletal Muscle Metastasis-A Case Presentation and Literature Review.

One-half of patients with newly diagnosed pancreatic cancer will have metastatic disease at the time of diagnosis, mainly due to its non-specific initial clinical presentation which includes abdominal pain, dyspepsia, weight loss, bowel habit changes, jaundice and pruritus. The signs, symptoms and stage of the disease at initial diagnosis depends on the origin of the primary tumor, with tumors of the head presenting earlier with obstructive symptoms while tumors of the body/tail are often diagnosed at an advanced stage due to their non-specific presentation. The most common sites of metastasis are the lymph nodes, liver, lung, and peritoneum. The presence of metastatic disease in the skeletal muscles is a rare manifestation of pancreatic cancer and has been described in a limited number of cases. We report the case of a pancreatic cancer patient with a solitary muscle lesion as the only site of extra-nodal metastasis upon initial presentation.

Uncommon disseminated muscular metastasis from suspected lung adenocarcinoma in a 18F-FDG PET/CT study.

Skeletal muscle metastasis from lung cancer is a rare phenomenon. In this case report, FDG PET/CT imaging detected unexpected metastatic spread in skeletal muscles from lung cancer.