Carcinoma Lung Presenting with Skeletal Muscle Metastasis: Case Report with Review of Literature

Lalchandani, Ankit; Shukla, Yogeshwar Prasad; Parwez, Mohammad Masoom

doi:10.1055/s-0041-1731636

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…This percentage is even lower for lung cancer metastasizing to muscle (0–0.8%) and skin (1.3–4%). STM in lung cancer is considered a grave prognostic indicator, with a median survival of less than 6 months, even with chemotherapy [ 9 ]. In a review by Pop et al, among 16 such patients, the 5-year survival rate was 11.5%, with a median survival duration of 6 months [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Theories posit that muscle contractions, which increase pressure in the tissues around them and fluctuate local blood flow, prevent tumor cells from implanting, accounting for STM’s rarity. Other limiting factors include specific homeostatic conditions that suppress tumor cell proliferation, constant trauma to cells due to muscle contraction, lactic acid production by skeletal muscle, and high tumor cell permeability [ 5 , 9 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Right Thigh Mass Metastasis from Lung Cancer Mimicking Primary Soft Tissue Sarcoma: A Case Report

Putro,

Prasetyo,

Magetsari

et al. 2024

Am J Case Rep

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Patient: Female, 47-year-old Final Diagnosis: Soft tissue metastasis from lung adenocarcinoma Symptoms: Pain and swelling in the right thigh Clinical Procedure: Biopsy Specialty: Oncology • Orthopedics and Traumatology Objective: Unusual clinical course Background: Soft tissue metastases (STMs) are less common than bone metastases and sometimes misdiagnosed as primary soft tissue malignancies. Skin, lungs, and breast are the most common primary lesions of STMs and rarely the presenting symptoms. We present an STM from lung adenocarcinoma that became a presenting symptom in nonsmoking woman. Case Report: A 47-year-old woman presented to our hospital with a painful mass in her right thigh and weight loss of 10 kg for 4 months. Femoral radiograph revealed a lesion suggestive of bone sarcoma. However, magnetic resonance imaging (MRI) showed it was more likely a primary soft tissue sarcoma. A small mediastinal mass was noticed on preoperative chest radiograph, and the patient denied any symptoms except the mass in the right thigh. Our clinicopathological conference team decided to perform a biopsy of mediastinal and right thigh masses. Histopathology examinations confirmed the right thigh mass as soft tissue metastasis from mediastinal mass, confirmed as lung adenocarcinoma. We treated the patient with palliative care with zoledronic acid and gefitinib. At the 6-month follow-up, the patient’s symptoms significantly improved, and MRI showed a marked size reduction. Conclusions: Diagnosis of STM can be difficult when presenting as the primary manifestation. Failure to identify promptly can lead to rapid disease progression and unfavorable prognosis. Failure to diagnose primary malignancy during biopsy occurs in approximately 28% of cases. This report has the potential to facilitate the avoidance of unnecessary procedures and highlight the importance of using a multidisciplinary approach in managing cases with malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Right Thigh Mass Metastasis from Lung Cancer Mimicking Primary Soft Tissue Sarcoma: A Case Report

Putro,

Prasetyo,

Magetsari

et al. 2024

Am J Case Rep

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“…The most common sites of skeletal muscle metastasis of lung cancer are the thigh, iliopsoas, and paraspinous muscles. Lesions have also been reported in the orbit and pectoral muscles [7][8][9][10]. Besides, some literature also reports the calf muscles being among the common spreading sites [11].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Lung Adenocarcinoma Metastasis to the Tricep Muscle: Four Years Disease-Free After Surgical Resection and Radiotherapy

Weeraddana¹,

Walgamage²,

Elkabbani³

et al. 2023

Cureus

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Lung cancer is one of the leading causes of cancer-related death worldwide. Lung cancer commonly metastasizes to the liver, bone, and brain, but metastasis to skeletal muscles is rare. The development of metastasis in skeletal muscles indicates stage IV disease with a poor prognosis. The most effective treatment strategy is unclear. Palliative radiotherapy is often used to treat skeletal muscle metastases, and patient survival is poor, with an average survival of one year. Here we discuss the case of a 76-year-old female diagnosed with lung adenocarcinoma with metastasis to the trapezius muscle. Initially, she was treated with stereotactic body radiotherapy for stage T1 lung adenocarcinoma. Her follow-up surveillance positron emission tomography (PET) scan in 11 months showed an abnormal focal area of increased activity localizing to the long head of the right triceps muscle. The diagnosis was confirmed with an ultrasound-guided biopsy of the trapezius muscle. Following that, the patient underwent wedge resection of the right middle and upper lobe of the lung and partial right trapezius resection. Afterward, she was given radiation therapy at the tricep resection site. She remained disease-free for four years after excision and radiation therapy.

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Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer

Díaz-Abad,

Aranaz-Murillo,

Mayayo-Sinues

et al. 2024

Diagnosis

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Objectives Lung cancer is the leading cause of cancer-related death and poses significant challenges in diagnosis and management. Although muscle metastases are exceedingly rare and typically not the initial clinical manifestation of neoplastic processes, their recognition is crucial for optimal patient care. Methods We present a case report in which we identify the unique scenario of a 60-year-old man with shoulder pain and a deltoid muscle mass, initially suggestive of an undifferentiated pleomorphic sarcoma. However, further investigations, including radiological findings and muscle biopsy, revealed an unexpected primary lung adenocarcinoma. We performed a systematic literature search to identify the incidence of SMM and reflect on how to improve and build on better diagnosis for entities as atypical as this. Results This atypical presentation highlights the importance of recognizing and addressing cognitive biases in clinical decision-making, as acknowledging the possibility of uncommon presentations is vital. By embracing a comprehensive approach that combines imaging studies with histopathological confirmation, healthcare providers can ensure accurate prognoses and appropriate management strategies, ultimately improving patient outcomes. Conclusions This case serves as a reminder of the need to remain vigilant, open-minded, and aware of cognitive biases when confronted with uncommon clinical presentations, emphasizing the significance of early recognition and prompt evaluation in achieving optimal patient care.

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Carcinoma Lung Presenting with Skeletal Muscle Metastasis: Case Report with Review of Literature

Cited by 4 publications

References 12 publications

Right Thigh Mass Metastasis from Lung Cancer Mimicking Primary Soft Tissue Sarcoma: A Case Report

Right Thigh Mass Metastasis from Lung Cancer Mimicking Primary Soft Tissue Sarcoma: A Case Report

An Unusual Case of Lung Adenocarcinoma Metastasis to the Tricep Muscle: Four Years Disease-Free After Surgical Resection and Radiotherapy

Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer

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