A case of uterine carcinosarcoma which was strongly suspected to have metastases to the psoas and gluteus muscles

Abstract

Metastasis to the skeletal muscles is uncommon. We report a case which was strongly suspected to have psoas and gluteus muscle metastases from uterine carcinosarcoma. A 68-year-old woman (gravida, 2; para, 0) underwent retroperitoneal endoscopic paraaortic lymphadenectomy, laparoscopic modified radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy for uterine carcinosarcoma, suspected to be stage IB. Metastasis to one right pelvic lymph node was observed. Ascites fluid cytology was negative. Postoperative pathological examination revealed stage IIIC1 (pT1bN1M0) disease. Five cycles of chemotherapy with paclitaxel + carboplatin were performed. 10 months after chemotherapy, serum cancer antigen-125 level was elevated. Computed tomography (CT) revealed a 3-cm tumor of the left psoas muscle and magnetic resonance imaging revealed a tumor of the left gluteus maximus muscle. These lesions showed fluorodeoxyglucose uptake in positron emission tomography-CT. Because we considered the tumors were metastases of uterine carcinosarcoma, we recommended her chemotherapy. However, after one cycle of chemotherapy, the patient underwent immunotherapy elsewhere with immune checkpoint inhibitors. 5 months after the recurrence, she was alive.

Solitary Cystic Psoas Muscle Metastasis From Rectosigmoid Adenocarcinoma

“…5 By contrast, we reviewed 2 case reports of good outcomes after resection of solitary muscle metastases from cervical cancer. 6,13 In conclusion, we report an interesting and unusual case of CRC metastasizing to the left psoas muscle initially diagnosed as a cystic lesion. Unlike other adenocarcinomas of the rectosigmoid junction, which normally metastasize to the liver or bone.…”

“…5 Another review of 52 patients with skeletal muscle metastases showed that the most commonly affected muscles are gluteus, psoas, and erector spinae. 6 According to a database from the Japanese Registry of Autopsies, the incidence of skeletal muscle metastases is 0.028%. 5 Other authors consider the prevalence of them between 0.03% and 5.6%.…”

“…1 As in our case, CT-guided fine needle aspirate is useful to differentiate abscess from psoas metastases. 6 In terms of diagnostic imaging, magnetic resonance imaging has more than 90% sensitivity for the detection of sarcoma and metastatic lesions in muscle, 7,10 when compared with CT.…”

“…5 By contrast, we reviewed 2 case reports of good outcomes after resection of solitary muscle metastases from cervical cancer. 6,13…”

Endometrial cancer recurrence in the sacrum and the Psoas: A case report and literature review

“…Musculoskeletal metastasis of gynecological cancers has been described in women mostly with cancer of the cervix and the psoas muscle is the most common site of metastasis ( Ishidera et al, 2018 ). Uterine cancer metastasis has been theorized to commonly include parametria, pelvic and paraaortic lymph nodes and less commonly the lungs, liver, bones and brain.…”