Abstract
BackgroundThe occurrence of skeletal muscle metastases is a very rare event. Only two cases of late skeletal muscle recurrence from cervical cancer have been documented until now.Case presentationA 38-year old patient, submitted to radical hysterectomy and pelvic lymphadenectomy for a squamous FIGO stage IB1 cervical carcinoma, presented after 76 months with a palpable, and painless swelling on the left hemithorax. MRI showed a nodule located in the context of the intercostal muscles. Pathology revealed the presence of metastasis of squamous cell carcinoma of similar morphology as the primary. On the basis of FDG-PET findings, which excluded other sites of disease, surgical excision of the lesion was performed. The patient was triaged to chemotherapy plus external radiotherapy.ConclusionA case of skeletal muscle recurrence from cervical cancer after a very long interval from primary diagnosis is reported. Muscular pain or weakness, or just a palpable mass in a patient with a history of cancer has always to raise the suspicion of muscle metastasis.
Highlights
The occurrence of skeletal muscle metastases is a very rare event
The reasons for the rarity of metastatic involvement of skeletal muscle are still unclear, but several hypotheses have been made including: a) the constant movement of skeletal muscles, which may represent a difficult condition for the implantation and growth of metastatic cells under the high tissue pressure related to the exercise associated increase of blood flow; b) the local production of lactic acid, which would create an unfavourable environment for metastatic cell growth; c) the inhibition of cell invasion by protease inhibitors located in the basement membrane; d) the antitumor activity of lymphocytes and/or natural killer cells within the skeletal muscle; e) in vivo evidences that skeletal muscle-delivered peptidic factors may influence the metastatization process [1]
The patient was triaged to combined chemotherapy with carboplatin (5AUC) and paclitaxel (175 mg/m2), plus external radiotherapy on the left hemi thorax
Summary
We first reported a case of isolated intercostal cage muscle recurrence after a very long interval from the diagnosis of squamous cell carcinoma of the uterine cervix. Ness of FDG-PET for staging, and for the detection of recurrence in cervical carcinoma: in our case FDG-PET findings showed to be critical in order to plan patient management since a diffuse metastatic disease was excluded, and surgical removal of the intercostal muscle recurrence could be planned. Late recurrence (i.e. after a disease-free interval of more than 5 years) in cervical cancer patients is considered a very rare event occurring in approximately 4% of cases with a frequency increasing from 1.8% in stage I, to 5.2% and 8.5% in stage II and III disease, respectively [14] These figures suggest that cervical cancer patients, especially those bearing stage II-III disease warrant long follow up care, because of the long period of tumor cell dormancy. Muscular pain or weakness, or just a palpable mass in a patient with a history of cervical cancer has always to raise the suspicion of metastatic muscular disease
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
