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Lumbar Muscle Metastasis from Lung Cancer—Report of a Case Domenico Ferrigno & Gianfranco Buccheri To cite this article: Domenico Ferrigno & Gianfranco Buccheri (1992) Lumbar Muscle Metastasis from Lung Cancer—Report of a Case, Acta Oncologica, 31:6, 680-681, DOI: 10.3109/02841869209083854 To link to this article: https://doi.org/10.3109/02841869209083854
Published online: 08 Jul 2009.
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clinically and pathological evidence of meningeal or intracerebral metastases was found in 60% of patients who underwent autopsy. One-third of their patients had bone metastases in the base of skull and choroidal metastases were found in 15% of the cases. These authors proposed that this distribution of metastases may indicate that the diabetes insipidus in such patients results from direct tumour extension from adjacent structures rather than solely from haematogenous spread. Our cases support this hypothesis and emphasise that eye symptoms may be a prominent additional manifestation of disease in this anatomical area. The association of diabetes insipidus with orbital metastases in breast cancer as occurred in case 2 has been reported only once previously ( I ) and in that case the orbital involvement was diagnosed three months after diabetes insipidus. Treatment of diabetes insipidus due to breast cancer with chemotherapy or endocrine therapy has been successful in a small number of cases (4). Excellent symptomatic control of the thirst and polyuria was achieved in both our cases with vasopressin replacement but despite a good anti-tumour response in case 2 it was unable to be discontinued without symptoms of diabetes insipidus recurring. This is somewhat unexpected as the posterior pituitary, unlike the anterior, receives its blood supply directly from the systemic circulation so systemic therapy should adequately penetrate this area. It is therefore likely that diabetes insipidus reflects actual destruction of neural tissue rather than just infiltration by tumour cells. This is consistent with the poor results of radiation therapy in palliating diabetes insipidus from malignant disease (1 of 19 patients responded) (1). LAWRENCE C THAM MICHAELJ MILLWARD MICHAELJ LIND BRIAN M J CANTWELL
University Department of Clinical Oncology Newcastle General Hospital Newcastle upon Tyne England
May 1992 Correspondence to: Dr. L. C. Tham, 49 The Chare, Leazes Square, Newcastle upon Tyne, NEI 4DD, England
REFERENCES 1. Kimmel DW, ONeill BP. Systemic cancer presenting as diabetes insipidus: clinical and radiographic features of l l patients with a review of metastatic-induced diabetes insipidus. Cancer 1983; 52: 2355-8. 2. Teears RJ, Silverman EM. Clinicopathologic review of 88 cases of carcinoma metastatic to the pituitary gland. Cancer 1975; 36: 216-20. 3. Houck WA, Olsen KB, Horton J. Clinical features of tumour metstasis to the pituitary. Cancer 1970; 26: 656-9. 4. Yap YK, Tashima CK, Blumenschein GR, et al. Diabetes insipidus and breast cancer. Arch Intern Med 1979; 139: 100911. 5. Cantwell BMJ, Idle M, Millward MJ, et al. Encephalopathy due to hyponatremia and inappropriate arginine vasopressin secretion following an intravenous ifosfamide infusion. Ann Oncol 1990; 1: 232.
roid cancer, and some other neoplasms ( 1-5). In an autopsy series of 747 cases of lung cancer, muscular metastases were observed in 8 cases only (1%); 4 of whom had squamous cell carcinoma (6). Hematogenous skeletal muscle metastasis of bronchial carcinoma are very rare at the clinical level (7- 13). We now present a case of a 70-year-old man with squamous cell lung carcinoma metastatic to the left lumbar muscle. Case report. A 70-year-old man presented in April 1989 with a 8-month history of hoarseness, cough, and hemoptysis. He had been a heavy smoker since the age of 22. At physical examination a painless mass in the left lumbar muscle was found and chest x-rays demonstrated a large round mass in the left upper lobe. Bronchoscopy showed an endobronchial mass in the left upper bronchus, and biopsy yielded the histological diagnosis of squamous cell carcinoma (G2), also confirmed by a positive reaction for keratin. CT of the thorax showed a tumor in the left upper lobe with mediastinal nodal involvement, and a metastatic mass in the lingula. Abdominal CT confinned the presence of a well-encapsulated soft tissue mass in the left lumbar muscle with a maximum diameter of 5cm. (Figure). Brain CT was normal. Surgical resection of the mass was performed and histology showed squamous cell carcinoma similar to the lung tumor, also confirmed by a positive keratin reaction. The patient received supportive and symptomatic care and died 5 months after the initial presentation with progressive generalized disease. Discussion. The dramatic increase in the incidence of lung cancer has also resulted in the recognition of rare patterns of metastases. Metastatic patterns are not random and appear to be dependent on properties unique to the tumor cell (4) and certain organs ( 5 ) . Several factors of importance for the establishment of metastases have been identified (14) and include detachment of tumor cells (IS), arrest of circulating tumor cells in the vascular endothelium at specific sites (4, 5, 16-18) escape into the tissues (21); and angiogenesis to permit the growth of the metastatic implant (19-21). Direct invasion of skeletal muscle in the chest wall and trunk is rather common in lung cancer and some other cancers (2, 22,23). Primary tumors in skeletal muscles are more common than secondary tumors (4, 21). The reason for the rarity of metastatic tumors in skeletal muscle is unclear, but could be related to factors such as blood flow, metabolism, and high tissue pressure (2, 5, 23). Organs with a high incidence of metastases such as lungs, liver, and bones of the skeletal axis are rich in capillary vasculature, and have a relatively constant blood flow (21). In contrast, the blood flow of skeletal muscle is extremely variable,
LUMBAR MUSCLE METASTASIS FROM LUNG CANCER-REPORT OF A CASE Metastasis in skeletal muscle is rare but has in autopsy series occasionally been found in leukemia, lymphoma, melanoma, thy-
Figure. CT image showing a metastasis in the left lumbar muscle.
and under the influence of /I-adrenergic receptors (24). Irrespective of blood flow, skeletal muscle tissue seems to be a poor milieu for tumors and this may be related to the lactic acid metabolism (4, 5, 21). However, skeletal muscles are easily subjected to trauma, and it has been shown that trauma of local areas may promote the growth of metastasis either by the release of growth promoting factors or as a trapping site for circulating tumor cells (25, 26).
ACKNOWLEDGEMENTS The authors would like to express their gratitude to Dr P. F. Giriodi and Dr A. Comino for technical assistance. DOMENICO FERRIGNO Medical Department GIANFRANCO BUCCHERI A. Carle Hospital of Chest Diseases Cuneo Italy April 1992 Correspondence to: Dr D. Ferrigno Medical Department, A. Carle Hospital of Chest Diseases, 1-12100 Cuneo, Italy.
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15. Folkman J. Tumor invasion and metastasis. In: Holland JF, Frei E, ed. Cancer medicine. Philadelphia: Lea & Febiger 1982: 167-77. 16. Wood S Jr, Baker RR, Marzocchi B. In vivo studies of tumor behavior: Locomotion of and interrelationships between normal cells and cancer cells. In: Proliferation and spread of neoplastic cells. Baltimore: Williams & Wilkins 1968; 495510. 17. Nicolson GL. Cellular interactions in blood-borne metastatic tumor spread to specific secondary sites. In: Day SB, Myers WP, Stansly P, et al., eds. Cancer invasion and metastasis: biologic mechanism and therapy. New York: Raven Press, 1977. 18. Chew EC, Josephson RL, Wallace AC. Morphologic aspects of the arrest of circulating cancer cells. In: Weiss L, ed. Fundamental aspects of metastasis. Amsterdam: North-Holland Publishing, 1975; 121 -50. 19. Kadish JL, Buttefield CE, Folkman J. The effect of fibrin of cultured vascular endothelial cells. Tissue Cell 1979; 1 1 : 99108. 20. Folkman J, Cotran RS. Relation of vascular proliferation to tumor growth. In: Richter GW, Epstein MA, eds. International review of experimental pathology. New York: Academic Press, 1976; 207-47. 21. Filder IJ, Hart IR: Principles of cancer biology, biology of cancer metastasis. In: De Vita VT, Hellmann S, Rosenberg SA, eds. Cancer, principles and practice of oncology. Philadelphia: J. B. Lippincott, 1982; 80-92. 22. Lasser A, Zacks SI. Intraskeletal muscle myofiber metastasis of breast carcinoma. Hum Pathol 1982; 13: 104-6. 23. Mulsow FW. Metastatic carcinoma of skeletal muscles. Arch Pathol 1943; 35: 112-4. 24. Sinclair DC. Muscles and fasciae. In: Romanes CF, ed. Cunninghams textbook of anatomy, ed. 12. New York: Oxford University Press, 1981: 265-8. 25. Agostino D, Cliffton EE. Trauma as a cause of localization of blood-borne metastases preventative effect of heparin and fibrinolysin. Ann Surg 1965; 161: 97-101. 26. Fisher B, Fisher ER, Feduska N. Trauma and the localization of tumor cells. Cancer 1967: 20: 23-30.
SIMULTANEOUS DISSEMINATED HERPES ZOSTER A N D BACTERIAL INFECTION IN CANCER PATIENTS The morbidity and mortality rates caused by infections are high in cancer patients (1). About half of all cancer patients have a serious infection when the granulocyte count is