Metastatic Soft Tissue Tumors

Abstract

Between 1998 and 2007, we treated 157 patients with malignant soft tissue tumors. Patients with obvious lymph node metastasis, metastasis from bone or soft tissue sarcoma, and with obvious advanced stage disease which had multiple metastases were excluded from the present analysis. Finally, sixteen of the 157 patients were diagnosed to have soft tissue metastasis from carcinomas or hematopoietic malignancies. There were 10 males and 6 females with an average age of 65 (range, 50 - 83) years. Four lesions were located in the abdomen and back, 3 in the thigh, 2 in the chest, and 1 lesion each in the upper arm, lower leg and buttock. There were 9 intramuscular and 7 subcutaneous metastases. The average tumor size was 6 cm (range 2 - 17 cm). The initial diagnoses were a primary soft tissue tumor in 8 cases, primary soft tissue tumor or metastatic soft tissue tumor in 6, and inflammatory lesions in 2. Four of the 6 cases were suspected to be a metastatic soft tissue tumor in the initial diagnosis based on a past history of malignancy. There were no characteristic findings of metastatic soft tissue tumors in the imaging studies. The primary origins were lung cancer in 6 cases, malignant lymphoma in 5, gastric cancer in 2, and esophageal cancer, pancreatic cancer and uterine cancer in 1 patient each. Treatments were administered to all cases, including radiotherapy and chemotherapy in 11, chemotherapy in 2, wide resection and chemotherapy in 1, radiotherapy in 1 and palliative therapy in 1. The final oncological status was continuous disease free survival in 1 patient, no evidence of disease in 1, alive with disease in 7, and dead of disease in 7 patients. The estimated one-year survival was 47% and the two-year survival was 0%

Upper limb soft tissue metastasis in post mastectomy patient

“…5 Regarding the primary neoplasm, only Plaza et al reported 13 cases/11% cases of breast carcinomas as the primary, 16% cases of skin carcinoma, 11% cases of lung carcinoma, 10% colon and 10% kidney carcinomas in 118 cases of soft tissue metastasis, while Damron et al and Torigoe et al highlighted lung carcinoma as the primary solid malignancy and lymphoma as the primary liquid malignancy apart from stomach, colon, esophagus, uterus and pancreas having the maximum tendency to metastasize to soft tissues as compared to breast. 4,5,6 Breast carcinoma generally metastasizes to bone, lung, liver, brain and lymph nodes, whereas soft tissue is not the usual site. As for the size of metastatic lesion, Konatam et al described a 15 cm × 7 cm swelling while we report a 21 cm × 17 cm soft tissue metastatic swelling.…”

“…As for the size of metastatic lesion, Konatam et al described a 15 cm × 7 cm swelling while we report a 21 cm × 17 cm soft tissue metastatic swelling. 6,4,9,10 Breast carcinoma is an aggressive disease with about 10-15% patients developing distant metastasis within 3-4 years, however such manifestation after 15 years is uncommon though not unusual in the present scenario of highly advanced diagnostic modalities, definitive and adjuvant treatment which has increased the life span of a patient where the metastatic state can manifest. This also implies that the patient harbours the risk of distant metastasis during their entire lifetime which is further enhanced by the heterogenous nature of the breast disease which makes it difficult to identify the risk factors and assess the curative modality.…”

“…4,5 Damron et al reported 25% while Torigoe et al reported 47% 1-year survival rate in the combined chemoradiation modality, thus indicating the poor prognosis of patients with soft tissue metastasis. 6,5…”

“…Metastasis to soft tissue from a primary malignancy is very rare with few case series of skeletal muscle meatstases from Sridhar [1][2][3][4][5][6][7][8][9] It can easily be misdiagnosed as a soft tissue sarcoma (STS) or an inflammatory lesion. 5,6 It is invariable to distinguish between a metastatic soft tissue tumor from other diagnostic pathologies as the management pattern and prognosis in all these entities are different and any overlap may cause unnecessary morbidity. 4 Histopathological and immunohistochemical (IHC) analysis plays the major role in differentiating and determining the primary lesion.…”

“…Metastasis to soft tissues is seen primarily in solid tumors like lungs, stomach, colon, esophagus, uterus and pancreas and haematological malignancies like lymphomas which have shown more propensities for soft tissue spread as compared to carcinoma breast. 5,6 Till date, breast carcinomas metastasizing to soft tissue, whether skeletal muscle or subcutaneous tissue has been rarely reported while only 7 previous cases of upper limb involvement have been described by Plaza et al, Surov et al and Konatam et al, thus establishing it as a rare entity and its early diagnosis and treatment are important for a better prognosis. 4,[9][10][11]…”