Gastric Adenocarcinoma in Skeletal Muscle-Literature Review and Report of a Rare Case of Metastatic Tumor

胃腺癌轉移至骨骼肌－稀少的案例報告及文獻探討

李易晟(Yi-Chen Li) ； 陳加榮(Jill Chen) ； 鄭勝峯(Seng-Feng Jeng) ； 謝焜州(Kun-Chou Hsieh) ； 陳建忠(Chien-Chung Chen)

《臺灣整形外科醫學會雜誌》 31卷3期 (2022/09) Pp. 213-222

摘要

Background: Although many conditions are considered in the differential diagnosis for soft-tissue masses, distant metastasis from a carcinoma or adenocarcinoma to skeletal muscles is usually not one of the primary diagnoses in such cases. Objective: We report a case of gastric adenocarcinoma that presented with skeletal muscle metastasis, and through this report, we aimed to increase awareness of the possibility of intramuscular metastasis of various forms of cancer. Material and Methods: Case presentation and literature review of skeletal metastatic tumors. Results: A 79-year-old man presented with an 8-cm right thigh mass three months after resection of gastric cancer. Subsequent pathological examinations revealed a gastric adenocarcinoma. In fact, many carcinomas can metastasize to skeletal muscles. The patients typically present with a palpable, occasionally painful mass in the lower limb. Investigations with magnetic resonance imaging (MRI) will often reveal malignant appearing tumors. Intramuscular metastasis signifies terminal disease, and the prognosis is extremely poor. The patient died 6 months after surgery due to the massive pleural effusion with respiratory failure. Conclusion: Thorough history-taking, detailed physical examination, and clinical awareness is crucial for detection and management of intramuscular metastatic tumors.

關鍵字

gastric adenocarcinoma ； skeletal muscle ； case report

並列摘要

背景：軟組織腫塊的鑑別診斷很多。然而腺癌的遠處轉移極其罕見，不常列入考慮。目的及目標：藉由個案我們希望介紹這種罕見的情況並提高醫師的臨床警覺性。材料及方法：病例介紹及癌症肌肉轉移的文獻討論。結果：79歲男性，胃腺癌切除手術後3個月因右大腿出現8公分腫塊至門診就醫，術後病理報告隨後證實為胃腺癌轉移，許多癌症都有骨骼肌轉移的可能性。患者通常在下肢摸得出的有時是無疼痛的腫塊。MRI影像檢查通常僅是惡性腫瘤表現，不容易做鑑別診斷。肌肉轉移預表末期疾病，預後極差。病人於術後半年後因肺積水合併呼吸衰竭死亡，可能和腫瘤惡質性有關。結論：全面的病史，詳細的理學檢查和保持臨床警覺對於肌肉內轉移性腫瘤的檢測和治療至關重要。